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Columbia  SBnttier^ftj) 

tnttieCttpofilfttigork 

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Mttiitai  Hibrarp 


Cbe 

Tilling  of  Cectb  mitb  Porcelain 


Ocnkins's  System.) 


J\  text  Book  Tor  Dentists  and  Students 


With   Ii6  Illustrations 


By  matter  lUclfsang  Bruck,  D.  D.  S. 

Instructor    in    the    Dental    Institute    of    the    Roval    University    of    Breslau 


Translated   From    the    German    by    Charles    IV.    Jejikins,    D.D.S.,    Zurich,    Germany. 
"Translation  Copyright  1902,  by  Consolidated  Dental  Mfg.   Co. 


new  Verk 
Consolidated  Dental  m'fg.  €o. 

11$  Ulest  42d  Street 


(To 

Bv,  "X.  :S.  Jfcntuns 

Bfil.  Sarijs.  l^ofrati) 
lHj&ittf   Sincere   lEsteem 

3ri)e  lluti)or 


Contents. 

Tirst  Division. 

Introduction ^ 

Historical    Development   of   Methods   of  Porcelain   Filling         ....         10 

Second  Division. 

Dr.  Jenkins's  Method  of  Making  Porcelain  Fillings. 

Chapter  I. — Indication  and  Contraindication  of  Porcelain  Fillings          .        .  15 

Chapter  II. — The    Preparation    of    the   Cavity 17 

Chapter  III. — Taking    Impressions 24 

Chapter  IV. — Investment  of  the  Impression  and  the  Melting  Process  .  36 
Chapter  V. — The  Preparation   of   Cavities  and  of  the  Completed  Filling  for 

Insertion    and    Fastening  in   Position 47 

Chapter  VI. — Application  of  the  "Porcelain  Enamel"  of  Dr.  Jenkins  to  the 

Restoration    of    the    Larger   Defects   in   Teeth       ...  52 

Conclusion 58 

Appendix. 

Porcelain  Inlays 61 

Dall's    System - 63 

Literature o6 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/fillingofteethwiOObruc 


Preface. 

The  gratifying-  fact  that  the  use  of  porcelain  as  a  material  for  filling 
teeth  is  constantly  growing,  and  that  in  consequence  of  the  good  results 
achieved  the  number  of  those  who  have  in  view  the  adoption  of  the  new 
method  is  steadily  increasing,  has  prompted  me  to  undertake  a  detailed 
description  of  this  innovation  which  undoubtedly  has  a  weighty  signifi- 
cance for  the  future  of  operative  dentistry. 

The  present  work  is  intended  to  afford  to  the  beginner  who  is  unac- 
quainted with  this  method  of  filling,  a  knowledge  of  it  in  all  its  scientific 
bearings,  and  to  be  a  faithful  guide  and  adviser  during  his  practical  study 
of  it ;  but  I  hope  it  may  also  give  to  those  who  are  already  skilled,  various 
information  hitherto  unknown  to  them  and  much  that  will  stimulate  them 
to  independent  work  in  this  field. 

The  preparation  of  porcelain  fillings  is  a  labor  demanding  much 
endurance  and  patience,  and  not  a  small  degree  of  accuracy  and  skill.  It 
requires  a  willing  thoroughness  devoted  to  apparently  unimportant  de- 
tails, and  it  should  not  be  supposed  that  it  makes  less  claims  on  the 
operator  than  filling  with  gold.  Yet,  since  porcelain  fillings  will  in  course 
of  time  become  indispensable  to  every  dentist,  the  sooner  a  good  degree 
of  skill  can  be  attained  in  their  use  the  greater  will  be  the  sucesses 
achieved. 

In  the  June  number,  1898,  of  the  Deutsche  Moiiatsschriff  fi'ir  Zaliii- 
hcilkundc,  I  published  an  article  on  the  new  Porcelain  Enamel  of  Dr. 
Jenkins,  which  was  the  first  German  publication  of  the  new  method.  Al- 
though I  could  then  only  report  the  result  of  trials  and  observations  which 
I  had  collected  in  a  few  weeks,  I  wrote  that  this  new  material  provided 
by  Dr.  Jenkins  seemed  destined  to  contest  rank  with  gold  in  many  cases, 
since  we  were  now  able  to  insert  fillings  scarcely  visible  to  the  naked  eye 
in  place  of  those  which  were  objectionable  to  many  patients  on  account 
of  being  too  conspicuous.  The  hope  based  on  the  new  material  at  that 
time  has  been  fulfilled  completely  and  beyond  expectation. 

It  is  now  nearly  four  years  that  I  have  been  using  the  Jenkins  Porce- 
lain Enamel,  during  which  time  I  have  made  many  hundreds  of  fillings 
with  it  for  all  kinds  of  cavities.  This  Porcelain  Enamel,  which  by  the 
way  has  in  the  meantime  undergone  various  improvements,  more  espe- 
cially in  color  resistance  to  heat,  is  so  excellent  a  composition  that  I  have 
had  almost  invariable  results  and  verv  few    mischances    in    working    it. 


PREFACE. 

Since  T  adopted  tliis  nictliDd  in  my  praoiice.  1  have-  had  opportunit}'  to 
show  the  method  of  woridng"  tlie  Porcelain  l^namel  to  a  not  inconsider- 
able number  of  colleaj^ues  as  well  as  to  the  students  of  dentistry  in  the 
Dental  Institute  (where  the  Jenkins  apparatus  was  installed  in  the  Ope- 
rative Department  1  and  it  is  now  my  wish  to  make  my  collected  experi- 
ences accessible  to  a  wider  circle  of  present  and  future  colleagues. 

In  the  original  illustrations  prepared  expressly  for  this  work  I  have 
attached  especial  importance  to  clearness,  as  I  am  well  aware  of  the  diffi- 
culty of  setting  forth  vividly  by  theoretical  explanation  a  purely  prac- 
tical subject.  I  therefore  regard  the  illustrations  as  a  most  valua1)k'  aid 
to  the  understanding  of  the  text. 

In  a  special  division  of  this  book  I  have  added  a  description  of  the 
Dall  method  of  inserting  already  prepared  porcelain  inlays,  because  there 
are  many  cases  in  which  it  is  to  be  preferred  to  the  entire  j^reparation  1)y 
the  operator  of  the  required  fillings. 

In  conclusion  I  would  not  fail  to  express  in  this  ])lace  my  heartiest 
thanks  to  Hofrath  Dr.  Jenkins  of  Dresden,  whose  various  suggestions 
have  aided  me  in  this  work  :  Prof.  Dr.  Ladenburg,  Privy  Councilor  and 
Director  of  the  Chemical  Institute,  and  Prof.  Dr.  Meyer.  Privv  Coun- 
cillor and  Director  of  the  Cabinet  of  Phvsics  in  the  Universitv  of 
I:>reslau,  also  deserve  warmest  recognition  for  seconding  me  in  my  labors. 

To  the  S.  S.  White  Manufacturing  Company,  and  to  Messrs.  Ash 
&  Sons  I  am  greatly  indebted  for  the  kind  loan  of  stereotype  plates. 

I  so  much  the  more  indulge  the  hope  that  this  book  may  be  favor- 
ably received  by  my  dental  colleagues  because,  while  isolated  articles 
on  the  subject  have  already  a]:)]:)eared,  there  has  been  as  yet  nothing  so 
comprehensive  as  this.  And  1  further  hope  that  by  means  of  this  work, 
which  owes  its  existence  to  years  of  conscientious  striving  in  a  sphere  of 
labor  most  promising  and  fruitful  in  its  relation  to  dentistry,  I  may  suc- 
ceed in  contributing  something  to  the  more  extended  use  of  the  valuable 
systems  of   Jenkins  and  Dall. 

\\'.\LrKK  \\'oi.ic, anm;  Rri'ck. 

lireslau.  ( )ctober.   i(;oi. 


Cbe  Tilling  of  Cectb  with  Porcelain. 


Bv  Walter   Wolfgaxg  Brick,  D.D.S. 


Translated  from   the  Gcriiian  by  Charles  W.  Jeukiiis.  D.D.S. ,  Zurich.  Germany. 


Tntroducticn. 

Although  the  number  of  preparations  used  m  the  fiUing  of  teeth 
attacked  by  caries  is  constantly  increasing,  and  although,  owing  to  their 
varied  qualities,  we  are  able  to  select  from  them  in  each  instance  the  one 
best  suited  to  the  individual  case,  yet  until  now  we  have  never  had  a 
filling  material  that  could  without  qualifications  be  described  as  "ideal." 

Prof.  Miller,  in  his  book  on  "Conservative  Den- 
tbe  Ideal  Tilling.       tistry,'"  has  summed  up  the  qualities  which  the  ideal 
filling  material  should  possess  as  follows : 
(i)    Sufficient  strength:  that  it  may  neither  break  nor  wear  away 
under  the  stress  of  mastication. 

(2)  Chemical  indestructibility:  that  it  may  remain  unaftected  by  the 
fluids  of  the  mouth,  or  by  any  food  or  drink. 

(3)  Permanence  of  form  and  volume  in  the  mouth. 

(4)  Thermal  nonconductivity :  that  changes  of  temperature  in  tlie 
mouth  may  not  be  conveyed  to  the  pulp. 

(5)  A  high  degree  of  adaptability:  that  it  may  be  made  to  fit  the 
walls  of  the  cavity  so  closely  as  to  exclude  moisture. 

(6)  Color  resembling  as  nearly  as  possible  the  color  of  the  tooth 
to  be  filled. 

(7)  Absence  of  every  quality  injurious  to  the  substance  of  the  tooth, 
including  the  pulp,  or  to  the  mucous  membrane,  or  to  the  general  health 
of  the  patient. 

(8)  Ease  of  insertion. 

(9)  The  least  possible  susceptibility  to  moisture. 

Among  filling  materials  we  indeed  possess  some  upon  which  we  can 
depend  for  good  results — for  example,  gold — and.  thanks  to  the  thorough- 
ness with  which  Dr.  W'itzel  has  developed  the  uses  of  aiiialgain.   we  en- 


10 

able  with  this  material  to  save  teeth  which  formerly  could  not  be  preserved. 
Other  preparations,  the  cements  and  giitta  percha,  often  render  us  good 
service;  but  there  is  no  one  of  these  which  unites  in  itself  all  the  require- 
ments, none  in  which  we  may  absolutely  trust,  none  which  deserves  to  be 
extolled  as  the  "ideal  tilling-  material."" 

On  account  of  its  durability  gold  must  always  stand  in  the  first  rank, 
but  gold  fillings  in  the  front  teeth  are  certainly  not  beautiful.  Amalgam 
cannot  be  considered  in  such  cases,  both  on  account  of  its  dark  color  and 
because  it  often  causes  discoloration  of  the  tooth;  therefore  our  only 
choice  has  been  gold  with  its  shimmering  lustre,  or  one  of  the  plastics 
like  cement,  which  disintegrates  in  a  comparatively  short  time.  For 
defective  front  teeth  we  need  a  material  that  shall  be  at  least  as  durable 
as  gold  and  more  sightly. 

As  I  shall  take  the  opportunity  to  show,  for  many  decades  dentists 
have  been  striving  to  find  such  a  material.  In  earlier  times  it  was  naturally 
more  difficult  to  attain  this  end,  for  the  dental  instruments  and  appliances 
with  which  dentists  worked  left  much  to  be  desired,  and  the  manufacture 
of  artificial  teeth,  which  has  furnished  incentive  for  many  attempts  in  this 
direction,  had  not  reached  the  perfection  of  today. 

With  the  increasing  perfection  of  tools  and  especially  of  dental 
appliances  we  are  now  in  a  position  to  employ  a  method  of  filling  that 
fairly  represents  the  most  perfect  dental  achievement. 

The  porcelain  filling  is  very  nearly  the  ideal  filling,  and  when  we 
consider  one  by  one  Prof.  Miller's  requirements  for  an  ideal  filling  ma- 
terial, we  shall  find  that  porcelain  meets  most  of  these  demands.  If  there 
be  still  some  minor  defects  in  the  methods  employed  in  the  use  of  porce- 
lain, we  may  hope  that  they  will  be  remedied  in  the  not  too  distant  future ; 
in  any  case  a  field  of  experiment  is  offered  in  which  we  can  expect  bril- 
liant and  useful  results. 

l)i$torical  Development  of  methods  of  Porcelain  Tilling. 

In  turning  over  the  leaves  of  the  dental  literature  of  past  decades, 
when  the  science  was  still  in  its  cradle,  and  there  was  not  even  one 
trustworthy  material  for  filling  in  use,  it  is  interesting  to  note  the  wish, 
often  expressed,  of  finding  a  material  that  should  satisfy  the  aesthetic 
sense  by  approaching  the  color  of  the  teeth.  I  regard  these  writers  as 
the  intellectual  originators  of  a  method  of  filling  which  is  not  only  suited 
to  bring  about  a  revolution  in  this  department  in  our  time,  but  is  also 
destined  to  have  an  important  influence  on  the  future  of  operative  den- 
tistry. 

The  first  to  take  up  this  kind  of  work  was  C.  J.  Linderer.  who  in 


11 

]820  described  processes  which  he  named  "founiieroi"  and  " plattieren" 
(inlaying  and  veneering)  of  the  teeth.  His  son,  Joseph  Linderer, 
improved  on  his  methods  and  published  a  book  describing  them  in  1834. 

The  plattieren  of  teeth  succeeded  best  with  shallow  cavities,  for  which 
were  used  small  flat  pieces  of  walrus  or  rhinoceros  tooth,  shaped  to  fit  the 
cavity.  If  the  depth  of  the  cavity  allowed,  small  pins  were  set  in  the  piece 
to  give  it  a  better  hold. 

For  the  ''foiiniicren"  which  Linderer  resorted  to  in  the  case  of  deep 
cavities,  he  prepared  rods  made  from  the  teeth  of  animals.  He  made  the 
cavity  circular,  tapping  the  section  to  place  with  light  blows  of  the  mallet, 
or,  after  cutting  a  thread  on  the  under  part  of  it,  screwed  it  into  place. 
These  inlays  swelled  in  contact  with  the  moisture  of  the  mouth  and  per- 
fectly sealed  the  cavity.  Linderer  relates  that  he  had  to  meet  with  violent 
opposition  among  his  colleagues,  who  often  condemned  his  method  with- 
out trying  it.  Thus  B.  Oenicke  in  1847  condemned  Linderer's  method 
because  "a  boring  out  of  the  cavity  would  be  necessary  which  would 
needlessly  injure  the  defective  tooth."  Bruck,  too,  in  his  textbook  on 
dentistry,  finds  this  method  "altogether  inadmissible." 

The  results  attained  with  "plattieren/'  and  still  more  with  "foiir- 
niereii,"  were  most  excellent.  The  only  reason  why  in  time  this  method 
fell  into  disuse  was  the  discoloration  of  the  inlays,  doubtless  the  result 
of  the  absorption  of  the  debris  of  food.''' 

Three  years  after  Linderer's  publication  of  his  methods,  in  1837, 
glass  was  first  actually  used  as  a  filling  material.  Dr.  Murphy  stated  in 
London  that  he  had  used  glass  for  the  labial  surfaces  of  front  teeth  bv 
melting  it  upon  a  piece  of  platinum  that  exactly  fitted  the  cavity.  The 
inlay  was  secured  in  place  with  amalgam. 

Probably  the  results  reached  were  not  very  good,  since  many  years 
passed  without  any  improvements  in  this  line  of  work.  Xot  until  1857 
was  any  progress  made,  when  A.  J.  \'olck  published  an  article  on  "The 
L'se  of  Porcelain  in  Filling  Cavities  in  Front  Teeth,"  in  the  American 
Journal  of  Dental  Science.  B.  Wood  followed  in  1862.  recommending  the 
use  of  porcelain  in  pieces  shaped  to  the  cavity  of  decay.  ]\Iarshall  H. 
Webb  states  that  the  American,  Hickman,  made  use.  in  1870,  of  pieces 
of  artificial  porcelain  crowns  for  filling  buccal  and  crown  cavities  n"" 
molars.  He  was  followed  by  E.  T.  A.  Starr,  who  had  such  pieces  of 
porcelain  prepared  of  different  shapes  and  provided  with  platinum  pins. 
These  pieces  needed  only  a  slight  preparation  of  the  edges  to  be  ready 
for  use. 

A  great  step   forward  in  the  development  of  this  method  must  be 


*In  1891   Dr.  Fenthol  of  Leif'zig  reported  tlir     -jse    of   ivory    for   inlays;    he    used    it.    like    Lin- 
derer. in  the  form  of  rods. 


12 

ascribed  to  Dr.  Land,  of  Detroit,  who,  in  1870,  made  the  experiment  ui 
fusing  pieces  of  artificial  teeth  in  a  platinum  impression  of  the  outer 
borders  of  the  cavity.  The  higli  point  of  fusion  of  the  material  as  well 
as  the  elaborateness  of  the  process  prevented  the  general  adoption  of 
this  method. 

In  1885  we  hear  of  a  new  development  through  an  article  published 
by  \\  .  H.  Rollins  in  the  Archives  of  Dentistry,  in  which  he  describes  a 
method  of  preparing  porcelain  fillings  used  by  him^ince  1879.  He  shapes 
the  walls  of  the  cavity  so  that  they  stand  perpendicular  to  its  floor,  and 
with  a  material  composed  of  two  parts  mastic,  one  part  parafifine  and  one 
part  graphite  takes  an  impression  of  the  cavity,  which  has  previously  been 
painted  over  with  vaseline.  This  is  placed  in  a  bath  of  sulphate  of  copper 
connected  with  a  battery,  and  the  plating  with  copper  requires  three  days ! 
He  now  removes  by  heat  the  impression  material  from  the  copper  mould, 
which  is  about  i>4  mm.  thick,  and  bores  a  hole  at  the  bottom  of  it.  Into 
this  mould  he  presses  a  piece  of  gold  foil  Xo.  30,  with  a  ball  of  cotton, 
fills  the  gold  foil  with  enamel  powder,  and  fuses  in  a  gas  muffle  furnace. 
Before  the  fused  mass  hardens  it  is  pressed  into  the  mould  with  a  platinum 
instrument.  After  cooling,  the  enamel  is  removed  from  the  mould  by 
thrusting  an  instrument  through  the  hole  previously  made,  and  the  gold 
is  drawn  oflf  from  the  piece.  The  fastening  in  place  is  eflfected  with  a 
mixture  of  zinc  oxide  and  gutta  perclia,  the  excess  which  oozes  out  being 
removed  with  chloroform.  This  method  approaches  in  many  particulars 
that  now  in  use.  but  is  so  tedious  that  it  has  not  found  general  favor. 

In  some  sort  as  a  reply  to  Dr.  Rollins.  C.  W.  Dunn  reported  in  the 
same  year  in  the  British  Journal  of  Dental  Science  a  method  practiced 
successfully  by  himself  since  the  year  1868.  which  had  the  advantage  of 
greater  simplicity.  He  took  the  impression  with  wax  attached  to  a  bit 
of  sheet  lead,  made  the  model  in  plaster,  which  he  then  painted  over  with 
a  mixture  of  wax  and  rosin  to  make  the  edges  less  friable,  and  ground  to 
fit  pieces  of  mineral  or  of  natural  teeth,  sometimes  using  those  of  cattle 
or  lambs. 

In  the  year  1887  J.  L.  Stokes  published  in  the  Southern  Dental  Journal 
a  method  very  similar  to  the  above,  the  only  variation  being  that  he 
shaped  the  cavity  of  decay  to  the  ground  inlay.  After  insertion  and  the 
hardening  of  the  cement,  he  followed  the  method  already  practiced  in 
the  seventies  by  Prof.  Essig  of  Philadelphia,  viz..  removing  the  cement 
from  the  interstice  at  the  edges  and  filling  it  with  gold. 

In  1889  W.  Storer-How.  in  an  article  in  the  Dental  Cosmos,  described 
in  minute  detail  the  process,  which  is  now  tolerably  well  known,  of  making 
inlays  by  grinding  pieces  of  artificial  teeth. 

In  the  same  year,  after  several  years  of  experiment.  Wilhclni  Herbst 


13 

put  torth  a  new  and  much  simplified  method  of  making  glass  fillings. 
Having  prepared  the  cavity  without  undercuts,  he  took  the  impression 
with  Stent's  Composition,  made  a  model  in  plaster,  removed  the  wax  with 
boiling  water,  and  filled  the  wet  cavity  of  the  model  to  about  three- fourths 
of  its  capacity  with  powdered  glass  moistened  with  water.  Then  he 
absorbed  the  moisture  from  the  glass  with  a  bit  of  linen,  dried  the  model, 
placed  it  on  a  piece  of  charcoal,  and  melted  the  mass  wdth  the  clear  flame 
of  a  Bunsen  burner  directed  by  the  blowpipe.  This  melting  was  repeated 
with  the  addition  of  glass  powder  until  the  mass  filled  the  cavity  to  the 
edges.  In  order  to  make  the  under  surface  of  the  filling  rough,  he  placed 
grains  of  sand  in  the  bottom  of  the  cavity,  which  united  without  melting 
with  the  glass  and  furnished  good  retention.*  Herbst's  invention 
awakened  much  interest  both  in  Germany  and  in  foreign  countries,  and 
it  is  not  to  be  denied  that  by  the  introduction  of  the  glass  filling  he  ren- 
dered great  service  to  the  development  of  the  methods  now  used  for 
porcelain  fillings.  Xot  only  did  there  follow  a  great  number  of  publica- 
tions in  the  dental  journals,  but  distinguished  practical  workers  set  them- 
selves to  improve  and  complete  the  process. 

Thus  in  1890  Prof.  Sachs  recommended  taking  the  impression  with 
Williams's  gold  foil  and  platinum  foil  No.  60,  instead  of  Stent's  Com- 
position, and  bv  means  of  this  mould,  obtained  direct  from  the  cavity 
itself,  secured  superior  exactness  at  the  margins.  After  Herbst,  several 
others  gave  their  attention  to  the  production  and  use  of  glasslike  sub- 
stances for  fillings,  among  them  Schlitsky,  ]\Ieyer,  Reisert  and  Robert 
Richter.  None  of  these  glass  preparations,  however,  have  maintained 
their  place  in  practice,  for  the  following  reasons :  In  the  first  place  glass 
is  not  homogeneous,  and  the  fillings  are  consequently  porous  and  do  not 
allow  of  grmding  and  polishing  after  insertion.  Glass  also  changes  color, 
owing  to  the  lead  to  be  found  in  most  kinds  of  it,  while  it  also  crumbles 
at  the  edges.  Consequently  the  hope  that  glass  would  prove  to  be  for 
many  cases  pre-eminenth'  a  useful  material  has  been  disappointing. 

There  was  now  a  return  to  the  earlier  practice  of  utilizing  artificial 
teeth  by  grinding,  and  tlie  inventions  of  means  by  which  this  difificult 
process  is  made  practically  useful  was  accomplished  by  the  dentist  Dali, 
of  Glasgow,  whose  most  excellent  system  will  be  described  in  a  special 
division  of  this  work. 

Heitmiiller.  of  Gottingen.  also  did  much  to  promote  the  use  of 
sections  of  artificial  teeth  in  filling. 

The  want  of   a   fillirig  material   which   should  be   suited  to  remedv 


*For  this  purpose   Hartman  puts  dry  plaster  at   the   bottom   of  the   gold   impression,   as   it    does 
not   unite   with   the   melting  glass. 


14 

carious  defects  in  leeth.  without  lacking  the  quahties  of  permanence  ana 
beauty,  induced  Dr.  Jenkins,  of  Dresden,  to  make  experiments  in  this  line, 
wiiich  he  began  about  the  year  189 1  and  continued  till  1898.  the  date  of 
his  first  publication  regarding  his  methods  of  filling.  He  has  succeeded 
in  inventing  a  combination  and  producing  a  substance  which  in  many 
respects  may  be  called  "ideal."  Apropos  of  the  success  which  Dr.  Jenkins 
has  achieved  with  this  fusil)le  composition,  it  may  be  mentioned  that  the 
famous  manufacturies  of  porcelain  which  flourish  in  the  neighborhood 
of  his  residence  gave  him  incentive  and  practical  support  in  the  production 
of  his  porcelain  enamel. 

After  Jenkins  had  introduced  his  material  to  the  profession,  Dentist 
Moser,  of  Frankfurt,  also  came  out  with  a  porcelain  preparation.  It  was 
claimed  by  the  inventor  that  it  had  the  advantage  over  the  Jenkins  enamel. 
which  is  a  powder,  of  being  furnished  in  small  pieces  which  would  ensure 
greater  homogeneousness  on  melting.  In  my  opinion,  however,  it  is  just 
this  form  of  the  Moser  composition  which  makes  it  objectionable,  since  by 
using  the  Jenkins  powder  the  melting  mass  can  be  easily  directed  to  every 
part  of  the  mould  and  the  exact  quantity  needed  can  be  applied,  while  in 
the  use  of  pieces  the  flow  of  the  melting  mass  is  a  matter  of  chance,  and 
the  resulting  height  of  the  filling  is  uncertain.  Nor  does  the  manner  of 
working  ^iloser's  material,  which  is  melted  over  a  Bunsen  burner  without 
investment,  easily  admit  of  a  correction  of  the  contour.  However,  in 
certain  cases  this  substance,  which  in  composition  is  nmch  like  that  of 
Jenkins,  can  be  used  with  good  results. 

Following  Aloser,  Dentist  Glogavi  invented  a  preparation  called 
"Kaolith."  which  he  believed  to  be  far  superior  to  the  Jenkins  porcelain 
enamel,  but  it  does  not  entirely  fulfil  the  expectations  wdiich  its  discoverer 
entertained  for  it. 

The  coloring  matter  of  fillings  made  of  this  material  is  a  pulverized 
enamel,  which  is  melted  upon  the  floor  of  the  impression  and  gives  the 
required  color  by  shining  through  the  stratum  of  Kaolith  that  is  made  to 
flow  over  it.  It  frequently  happens  that  the  powdered  enamel  does  not 
confine  itself  to  the  base  of  the  filling,  but  mixes  with  the  general  mass. 
Moreover,  the  finished  filling  has  the  disadvantage  of  a  glassv  lustre. 
rather  than  a  uniform  shade  of  color. 

Dr.  Jenkins  has  certainly  rendered  operative  dentistry  a  great  service. 
At  all  events,  his  porcelain  enamel  has  been  crowned  with  the  highest 
success.  As  his  discovery  was  made  in  Germany,  it  naturally  awakened 
the  greatest  interest  among  German  dentists,  which  is  shown  bv  the  fact 
that  there  is  scarcely  a  dental  meeting  in  which  either  a  paper  treating  of 
the  Jenkins  System  or  a  demonstration  is  not  on  the  programme. 

With  few  exceptions  reports  on  the  use  of  the  lenkins  method  have 


15 

been  most  favorable.  It  is  natural  that  in  judging  of  an  innovation  of 
this  kind  mischances  that  are  unavoidable  in  the  beginning  should  make 
a  great  impression.  Discouraged  by  such  causes,  many  give  up  further 
trials  as  useless  and  become  opponents  of  a  system  which,  pursued  with 
patience  and  persistence,  is  destined  to  be  of  immense  value  in  practice. 

Being  of  the  opinion  that  one  ought  not  under  any  circumstances  to 
exclude  from  examination  any  improvements  that  seem  to  have  actual 
value.  I  have  tested  all  the  glass  and  porcelain  preparations  obtainable, 
and  have  come  to  the  conclusion  that  there  is  no  other  material  with 
which  w^e  can  make  better  porcelain  fillings  than  with  the  Jenkins  porce- 
lain enamel. 

Not  only  in  Germany,  but  also  in  America,  has  this  method  received 
deserved  attention,  and  its  invaluable  qualities  are  being  recognized  there. 
At  a  meeting  of  the  Xew  York  Odontological  Society,  the  President,  Dr. 
S.  G.  Perry,  said  :  "AXe  are  standing  at  the  beginning  of  a  new  era  of 
great  significance.  The  time  appears  to  be  approaching  when  gold  fillings 
in  front  teeth  will  be  regarded  as  a  relic  of  a  forgotten  and  barbaric  age/' 

It  is  not  impossible  that  a  better  substance  than  this  may  come  into 
use :  yet  I  think  that  for  a  probably  long  period  we  shall  find  in  porcelain 
enamel  a  material  not  to  be  surpassed  :  a  material  by  means  of  which 
we  can  render  both  our  patients  and  ourselves  distinguished  and  satis- 
factory service. 


Tndication  and  Contra -indication  of  Porcelain  Tillings. 

The  position  of  teeth  in  the  mouth,  tlie  quality  of  tooth  structure, 
and  the  size  of  the  cavity  of  decav  are  the  conditions  upon  which  the 
adaptability  of  porcelain  fiUir.gs  depends. 

Moreover,  it  is  wise  for  such  as  have  but  recently  begun  to  practice 
this  method  to  let  the  choice  be  governed  by  the  extent  of  proficiency 
already  acquired.  If  one  has  not  yet  become  thoroughly  familiar  with 
the  preparation  of  cavities,  the  taking  of  impressions  and  the  melting 
process,  it  is  better  to  confine  oneself  in  the  use  of  porcelain  to  laliial  and 
cervical  cavities  and  cuneiform  defects. 

For  such  cavities  we  always  prefer  a  material  which  restores  as  far 
as  possible  the  original  appearance.  The  taking  of  impressions  from  these 
accessible  cavities  is  comparatively  easy,  and  the  melting  does  not  makv 
excessive  demands  on  the  operator. 

But  before  one  proceeds  to  fill  teeth  for  patients  he  should  acquire 
facility  by  experiments  out  of  the  mouth,  since   just  in   the  proportion 


16 

that  a  successful  tilliug  of  this  kind  coutributcs  to  the  preservatiou  of  the 
tooth,  in  just  that  (proportion  docs  a  filling  fail  of  doing  so  if  it  is  in  any 
respect  imperfect. 

The  employment  of  porcelain  tillings  has  the  great  advantage  over  the 
use  of  other  materials  that  it  is  seldom  followed  by  secondary  decay. 
Ex'en  those  zvho  have  entircl\  mastered  this  method  should  use  their  best 
discretio)i  in  the  choice  of  cases. 

As  1  have  already  mentioned,  porcelain  fillings  are  indicated: 

(i)   For  labial  cavities. 

(2)   For  cervical  cavities  and  cuneiform  defects. 

( Ti)   Tor  buccal  cavities  in  molars. 

(4)  For  all  approximal  cavities  where  the  piece  to  be  inserted  will 
not  upon  occlusion  be  touched  by  the  antagonizing  tooth. 

(5)  For  large  defects  caused  by  caries  or  fracture. 

As  above  noted,  the  restoration  with  porcelain  of  defects  cited  in 
I,  2  and  3  is  desirable  on  account  of  the  conspicuousness  of  the  positions, 
where  we  should  aim  to  avoid  attracting  attention  to  the  repair. 

Buccal  cavities  in  molars  which  often  extend  under  the  gum  margin, 
are  suited  to  this  method,  because  by  its  aid  we  can  make  a  better  joint 
than  with  any  other  material. 

F(»r  approximal  cavities  in  incisors,  cuspids  and  bicuspids,  porcelain 
is  always  to  be  preferred  on  aesthetic  grounds  in  cases  w'here  the  position 
and  play  of  the  lips  make  these  teeth  visible  in  speaking,  so  that  the  gold 
or  amalgam  fillings  would  appear  unsightly.  Further,  porcelain  fillings 
are  to  be  recommended  for  all  cases  of  extensive  decay  where  enough  of 
the  tooth  is  left  to  give  a  strong  attachment  and  an  entire  crown  is  not 
absolutely  required. 

Porcelain  fillings  are  contraindicated: 

( 1 )  For  crown  cavities  in  l:)icuspids  and  molars  where  severe  usage 
in  masticating  may  readily  occasion  fracture. 

(2)  For  approximal  cavities  where  the  force  of  mastication  is  likely 
to  dislodge  the  filling. 

(3)  In  all  those  smaller  visible  cavities  where  gold  is  not  strikingly 
noticeable. 

(4)  For  small  circular  cavities  which  can  be  more  readily  filled  by 
using  DalTs  prepared  inlays. 

(5)  For  those  shallow  cavities  where  sufficient  depth  cannot  be 
secured  without  too  great  sacrifice  of  sound  dentine. 

(6)  In  the  case  of  all  cavities  where  it  is  impossible  to  get  a  perfect 
impression. 

From  the  examples  given  we  learn  to  what  cases  this  method  applies 
and  to  what  others  it  is  unsuited.     In  any  case  it  is  better  to  judge  care- 


17 

fully  beforehand  than  to  discover  a  mistake  only  on  the  completion  of  the 
filling. 

Especially  would  I  discourage  any  blind,  excessive  application  of 
this  method.  Porcelain  inlay  work  requires  no  less  skill  and  persistence 
than  filling  with  gold,  and  there  are  many  cases  where  a  gold  filling  guar- 
antees a  surer  success.  Particularly  is  one  tempted  at  first,  having  been 
successful  with  a  few  fillings,  to  throw  overboard  the  old  ways  because  of 
admiration  for  the  new.  That  is  indeed  a  great  mistake,  which  can  only 
lead  to  disaster. 

By  using  the  greatest  possible  deliberation  as  to  the  cases  in  which 
one  may  employ  porcelain  to  real  advantage,  one  will  learn  to  save  time 
and  labor  and  to  avoid  those  unhappy  failures  which  tend  to  bring  the 
method  into  disfavor  with  the  public. 

In  the  preparation  and  insertion  of  porcelain  fillings  the  dentist 
should  subject  himself  to  the  severest  self-criticism  and  be  content  only 
with  absolutely  perfect  fillings,  since  any  tilling  of  whatever  material  is 
to  be  preferred  to  a  porcelain  filling  ivhich  is  not  in  every  respect  excellent. 

II. 

Cbc  Preparation  of  tbe  ^mvi. 

In  porcelain  inlay  work  the  preparation  of  the  cavity  is  of  the  utmost 
importance.  There  are  three  rules  which  must  be  observed  under  all 
circumstances,  viz. : 

I.  The  cavity  must  be  prepared  ivithont  undercuts. 

II.  Tlie  margins  must  be  sharply  defined,  strong  and  perfectly 
smooth,  but  not  beveled. 

III.  The  cavity  must  not  be  so  shallozv  that  the  tilling  cannot  be 
secured  in  place. 

The  neglect  of  even  one  of  these  precautions  absolutely  excludes  the 
possibility  of  success.  It  is  impossible  to  promote  the  preservation  of  the 
tooth  in  the  smallest  degree  with  an  imperfect  porcelain  filling,  while  with 
a  perfect  one  we  can  prolong  the  life  of  a  carious  tooth  and  essentially 
heighten  its  fimctional  capacity. 

As  mentioned  previously,  almost  all  cavities  are  suited  to  receive  por- 
celain fillings.  Init  I  will  enumerate  here  once  more  such  as  are  to  be 
considered,  that  I  may  describe  their  preparation  in  due  order. 

The  simpler  cases  are  those  presenting  on  : 

( 1 )  Labial  surfaces  of  incisors  and  cuspids. 

(2)  Cervical  surfaces  and  in  wedge  shaped  defects  amounting  to 
deformity. 

(3)  Buccal  surfaces  of  molars. 


18 


More  difficult  arc  those  occurring  on: 

(4)  Approximal  surfaces  of  incisors  and  cuspids. 

(5)  Approximal  surfaces  of  bicuspids  and  molars. 

(6)  Where  fracture  or  caries  has  caused  great  loss  of  substance  in 
front  teeth. 

In  the  cases  scheduled  in  i,  2  and  3,  we  excavate  thoroughly  and 
deepen  the  cavity,  taking  care  not  to  injure  the  pulp.  When  it  is  not 
possible  to  obtain  sufficient  depth  by  removing  the  carious  dentine  without 
disturbing  the  pulp,  we  resort  to  a  slight  hollowing  out  either  in  the  direc- 
tion of  the  neck  or  of  the  cutting  edge  (avoiding  undercut!)  which  will 
give  the  filling  a  good  hold  (Figs,  i  and  2). 

It  is  better  to  devitalize  exposed  pulps  than  to  cap  them.  After 
removal  of  the  dead  pulp,  this  hollowing  out  is  of  course  not  necessary, 


Fig.  1. 


for  we  can  then  deepen  the  cavity  to  our  liking  and  ensure  a  tirm  hold. 
It  is  better  to  use  rose  burs  adapted  to  the  size  of  the  cavity.  With  the 
larger  ones  we  can  almost  completely  give  the  right  shape  to  a  large 
cavity. 

Owing  to  their  favoring  position  cavities  i.  2  and  3  are  more  easily 
prepared  than  those  on  the  approximal  surfaces  of  incisors,  cuspids, 
bicuspids  and  molars. 

In  these  latter  cases  it  will  generally  be  neces- 
sary to  separate  the  teeth  in  order  to  get  a  good 
impression,  which  is  best  done  liefore  beginning  the 
excavation,  as  one  thereby  gets  a  better  view  of  all 
therefore  a  few  words  here  as  to  separation. 
The  relatively  simplest  means  of  securing  sufficient  interproximal 
space  is  the  wedging  of  absorbent  cotton  between  the  teeth  and  letting  it 


Separation  of 
the  teeth. 

parts  of  the  cavity 


19 

remain  a  day  or  two.  Press  into  the  space  a  dry  piece  and  follow  it  with 
one  dipped  in  mastic.  The  dry  piece  will  swell  on  absorbing  moisture, 
while  the  mastic  will  prevent  the  wedge  from  falling  out. 

This  way  of  separation  has  the  disadvantage  that  it  must  sometimes 
be  repeated,  which  requires  time  not  always  at  command  in  the  case  of 
patients  coming  from  a  distance,  and  also  that  patients  are  annoyed  by 
the  soreness  occasioned  by  prolonged  pressure. 

Therefore  it  is  better  when  practicable  to  undertake  immediate  sepa- 
ration. 

This  is  to  be  accomplished  by  the  customary  filing  with  separating 
files  (Fig.  3).    In  order  not  to  sacrifice  more  of  the  enamel  than  is  abso- 


Fig. 


lutely  necessary,  we  emplo}',  after  usmg  the  lowest  number  of  file  (000-0), 
some  of  the  many  separators,  of  which  the  Ivory  and  the  so-called  "Little 
Giant'^  may  be  noted. 

Ivory's  separator  (Fig.  4)  consists  of  two  wedge  shaped  spurs  filed 
to  a  point,  one  of  which  is  fastened  to  a  small  hoop,  while  the  other  is 
attached  to  a  screw,  which  being  turned  pushes  this  movable  wedge 
towards  the  fixed  one.  The  stationary  spur  is  placed  at  the  approximal 
space  on  the  palatal  or  lingual  side  of  the  teeth  ;  the  movable  one  on  the 
labial  or  buccal.  As  the  wedges  are  made  to  approach  each  other  by  slow 
turning  of  the  screw,  the  space  between  the  teeth  constantly  increases. 
On  the  first  introduction  of  this  instrument  we  should  only  screw  the 
wedges  towards  each  other  sufficiently  to  hold  it  in  place  and  afterwards 


20 


proceed  by  slow  stages,  since  the  pressure  is  unpleasant  for  the  patient 
and  too  quick  or  violent  wedging  may  occasion  periostitis.  It  is  a  pity 
that  this  separator  is  made  in  one  size  only,  which  does  not  apply  to  all 
cases.     The  spurs  should  have  differing  shapes  and  be  interchangeable. 


"'jMBil 


Fig.  6. 


The  "Little  Giant"  separator,  which  is  to  be  had  in  three  different 
sizes  (Fig.  5),  consists  of  a  fine  threaded  screw,  at  one  end  of  which  a 
wedge  is  fastened,  with  a  second  of  similar  shape  sliding  upon  it  and 
moved  by  means  of  a  nut,  which  is  turned  up  with  a  key  (Fig.  6),  thus 
pushing  the  two  points  together.  The  principle  of  this  device,  like  that 
of  the  Ivory,  is  pressure  from  two  wedges  approaching  each  other.  Fig.  7 
shows  the  instrument  in  position. 


Am 


Fig.  7. 


Wedging  with  wood  is  unpleasant  for  the  patient,  yet  is 
to  be  recommended  for  many  cases,  that  is  to  say,  when  the 
space  to  be  gained  is  small.  The  sharpened  hickory  wood'''' 
should  be  spear  shaped  (Fig.  8).  Drive  in  with  light  taps  of 
the  mallet  or  by  hand  pressure  as  far  as  (a)  of  the  spearhead. 
The  wedge  should  remain  in  position  without  slipping  until 
the  operation  is  completed.  Improperly  shaped  wedges  will 
loosen  and  fall  out.  Fig.  s. 

In  most  cases  that  present,  themselves  some  one  of  these 
methods  will  suffice ;  but  in  cavities  that  extend  under  the  gum  the  use 
of  cotton  as  above  described  is  imperative  in  order  to  force  the  gum  which 
intrudes  upon  the  cavity  as  much  as  possible  away  from  the  tooth. 


"The  orangewood   o{  the  depots   is   unsuited   to  this  purpose  because  it  is  often  pithy  inside. 


21 

In  Fig.  9  I  present  a  method  which  I  practice  now  and  then  of 
placing  an  underlay  of  amalgam  at  the  bottom  of  cavities  that  extend  very 
far  under  the  gum.    This  essentially  facilitates  the  taking  of  the  impression. 

We  may  now  take  up  the  preparation  of  approxi- 

flpproximal  mal  cavities.     If  the  labial,  palatal  or  lingual  wall  of 

Cavities.  a  cavity  be  especially  weak ;  if,  as  often  occurs,  there 

is  onlv  a  stratum  of  enamel,  it  should  be  removed 


Fig.  11. 


Fig.  12. 


Fig.   13. 


^ 


Fig.   14. 


Fig.  15. 


with  an  enamel  chisel,  since  it  is  easily  fractured,  and  the  success  of  the 
filling  is  only  apparent.  In  any  case  one  should  provide  broad  access  to 
approximal  cavities,  for  weak  walls  can  be  most  effectually  restored  by  a 
porcelain  filling.  As  before  remarked,  teeth  which  have  suffered  great  loss 
of  substance  can  often  be  strengthened  and  made  useful  by  this  new 
agency.     In  Fig.  lo.  I  illustrate  the  preparation  of  an  approximal  cavity 


22 


in  a  bicuspid ;  (/  sliows  the  mesial  surface  attacked  by  caries,  b  the  exca- 
vated cavity  which  extends  to  the  fissure,  c  the  shape  of  the  cavity  at  the 
coronal  edge. 

When  one  has  secured  the  space  necessary  for  the  withdrawal  of  the 
impression,  and  completely  removed  the  weak  walls  and  softened  dentine, 
he  begins  with  the  special  preparation  of  the  cavity. 


i    i    0   i 

i  1         I 


Fig.   16. 

The  hollowing  out,  represented  in  Fig.  ii,  is  also  to  be  recommended 
for  approximal  cases.  It  is  better  in  such  instances  to  make  it  near  the 
cervical  edge,  though  a  weakening  of  the  wall  is  of  course  to  be  avoided. 
If  the  loss  of  tooth  structure  in  an  incisor  is  so  great  as  to  include  a 
]iortion  of  the  biting  edge,  as  shown  in  Fig.  ii,  there  is  one  important 
item  wliich  in  excavating  we  must  not  leave  out  of  our  reckonine.     If  we 


Fig.  17. 


give  the  cavity  the  shape  indicated  by  the  dotted  line,  the  frail  corner  of 
the  inserted  filling  at  the  biting  edge  will  break  away  in  a  short  time  and 
present  the  appearance  shown  in  Fig.  12.  We  must  seek  to  prevent  this 
by  cutting  a  semi-circular  groove  on  this  edge,  as  in  Fig.  13;  l)y  this 
means  such  an  accident  is  rendered  impossible. 

For  the  preparation  of  cavities  where  great  loss  of  substance  does  not 
permit  of  a  prescribed  rule,  we  must  of  course  treat  each  case  differently, 
observing  all  established  points  of  procedure.  Some  such  cases  are 
described  in  the  last  chapter  of  this  division. 


23 


The  shape  which  the  operator  must  give  to  all  the  cavities 
mentioned  is  that  of  a  trough.  One  should  avoid  a  perfectly  round 
since  thereby  the  trial  and  final  setting  of  the  inlay  is  made 
more  difficult.  Altogether  the  most  important  part  of  the 
preparation  is  the  finishing  of  the  margins.  I  have  set  forth 
as  the  second  rule  of  importance  that  they  should  be  sharply 
defined,  strong  and  perfectly  smooth,  but  not  beveled.  What 
I  intend  by  this  is  made  clear  by  Fig.  14a  and  b,  and  15c 
and  d.    While  14a  represents  the  section  of  a  properly  pre- 


above 
shape, 


f     f    f    f  99f   #   # 


Fig.  19. 

pared  cavity  whose  margins  are  sharp  and  show^  no  bevel, 
Fig.  15c  gives  the  section  of  one  improperly  prepared.  The 
margins  in  14a  are  sharp,  those  in  15c  rounded  oft".  If  w^e 
put  a  filling  in  the  properly  shaped  cavity  14b,  an  injury 
under  stress  of  mastication  is  not  likely  to  occur.  But  if 
as  in  Fig.  I5d  thin  portions  of  the  filling  overlap  the  edges, 
they  will  split  oft'  at  the  points  indicated  by  the  arrows. 


5 


rr 


Fig.  20. 

For  grinding  and  polishing  the  margins  we  use  pear 
shaped,  barrel  shaped  and  round  finishing  burs  (Fig.  16). 
We  must  confine  their  use,  however,  to  the  inner  walls  of 
the  cavity,  never  allowing  them  to  slip  over  the  margins 
(Fig.  17),  or  we  shall  bring  about  the  wrong  condition 
censured  in  Fig.  15c. 


Fis.   1! 


24 

If  we  examine  with  a  lens  (Fig.  i8)  a  cavity  prepared  in  conformity 
to  the  conditions,  the  edges  which  seem  smooth  to  the  naked  eye  will 
exliibit  many  inequalities.  To  remove  these  we  use  pear  shaped  and  round 
finishing  burs  coated  with  diamond  dust  (Fig.  19).  More  recently  the 
small  Arkansas  stone  points  suggested  by  Dr.  Jenkins  have  come  mto 
favor  for  this  purpose  (Fig.  20). 

Only  by  closely  following  (///  the  directions  given  in  this  division  shall 
we  be  able  to  obtain  faultless  impressions  from  the  prepared  cavity  and 
with  these  reach  good  results  in  porcelain  filling. 

III. 

Cakiiid  Tmpmslons. 

As  I  have  taken  frequent  occasion  to  emphasize  the  fact  that  in  order 
to  obtain  satisfactory  results  especial  care  must  be  taken  in  the  prepara- 
tion of  cavities,  so  at  once  I  wish  to  point  out  that  the  getting  a  good 
impression  is  of  equal  importance  to  the  success  of  porcelain  fillings. 

Unless  the  iiiipressio)i  be  perfect  if  is  impossible  that  the  tilling  shonhi 
serve  in  the  least  degree  to  preserve  the  tooth. 

It  cannot  therefore  be  too  often  emphasized  that  taking  the  impres- 
sion is  at  the  same  time  the  most  important  and  the  most  difficult  pari 
of  the  procedure.  Not  until  by  continued  practice  one  has  acquired  great 
skill  in  taking  impressions  of  all  sorts  is  he  qualified  to  use  this  method 
with  success.  This  or  that  difficulty  which  one  meets  at  the  beginning  he 
must  learn  with  patience  to  surmount,  since  it  is  only  by  the  study  of 
failures  that  we  learn  to  avoid  them. 

Whenever  the  situation  of  the  cavity  renders  it 
Rubber  possible  it   is  advisable   in   taking  an  impression  to 

Dsm.  adjust  the  rubber  dum.     For  example,  in  labial  cavi- 

ties in  the  front  teeth,  where  the  Ivory  clanq)  holds 
the  dam  well  away  from  the  field  of  operation.  The  two  neighboring 
teeth  must  also  be  included  in  the  isolation,  in  order  that  the  rubber  may 
not  interfere  with  the  gold  foil  of  the  impression  and  perhaps  alter  itb 
position. 

Should  it  be  impossible  to  use  the  rul)ber  dam  and  clamp — if,  for 
instance,  the  cavity  extends  beneath  the  gum,  tliere  remain  two  methods 
of  procedure  by  means  of  which  we  may  keep  the  region  perfectly  drv. 

The   napkins,    of   linen,    about    20    cm.    square, 

Dental  napkins.         should   be  folded  triangularly.      For  cavities   in   the 

front  teeth  the  point  of  the  triangle  will  be  placed 

under  the  lip  (Fig.  22)  ;  in  the  case  of  cavities  farther  l)ack  in  the  mouth, 

pressed  against  the  cheek,  and,  as  shown  in  Figs.  22.  23,  vvill  be  held  in 


25 


place  against  the  alveolar  process  by  the  lip  or  cheek  and  the  help  of  a 
finger.  The  broader  portion  of  the  napkin  may  be  pushed  into  the  month 
to  form  for  a  time  an  effectual  protection  against  saliva. 


This  is  an  instrument  which  1  constructed  sev 
Saliva  Clamp.         eral  years  ago  for  use  in  crown  and  bridgework  and 
also  in  oth.er  cases  not  admitting  the  use  of  the  rubber 
dam,  to  avoid  disturbance  from  the  flow  of  saliva.     It  is  made  in  two 


forms,  one  for  use  on  the  right  and  one  for  the  left  side,  and  serves  to 
exclude  during  the  operation  the  flow  from  the  parotid  gland  through  the 
duct  of  Steno.     As  seen  in  Fig.  24.  this  instrument  is  in  the  form  of  a 


26 


pair  ui  scissors,  one  arm  of  which  ends  in  a  flat  ball  designed  to  cover  the 
duct  of  Steno,  while  the  other  is  shaped  as  a  ring  that  presses  against  the 


Fig.   23. 

outside  of  the  cheek.  The  two  arms  are  held  together  by  a  spring  attached 
quite  sufficient  to  fix  the  instruments  to  the  handles.  Light  pressure  is 
in  place,  and  in  the  case  of  sensitive 
patients  cotton  can  be  placed  over 
the  ends.  As  I  have  already  made 
clear  in  the  September,  1900,  num- 
ber of  the  Deufschen  Monatschrift 
fiir  Zahnheilkundc,  in  which  I  de- 
scribed this  device,  no  evil  conse- 
quences from  this  confinement  of 
the  saliva  have  been  observed.  Fig. 
25  shows  the  instrument  in  position. 

For  e  X- 
tbe  Raruard  Clamp,  eluding  saliva 
I  have  also 
used  the  Harvard  clamp  (Fig.  20) 
in  many  cases,  applying  it  to  one 
of  the  adjoining  teeth.  By  means 
of  the  two  arms  which  carry  ab- 
sorbent cotton  rolls  we  can  keep 
the  field  of  operation  a  long  time 
free  from  saliva.  This  clamp  is 
made   for  bicuspids   and   molars. 

'"ig.   24. 


27 

After  the  tooth  and  neighboring  parts  have  been 
taking  dried,  the  tooth  should  be  painted  over  with  some 

the  Impression.         fatty  substance,  in  order  to  make  the  withdrawal  of 
the   gold  foil   impression  easier.     Jenkins   uses  vase- 
line for  this  purpose.     I  have  used  with  the  best  results  fine  olive  oil 
applied  thinly  with  a  brush. 


Fig.  25. 


V'arious  aids  have  been  presented  to  render  the  taking  of  impressions 
easier.  It  has  been  proposed  to  take  first  an  impression  of  the  cavity  with 
Stents's  Composition  or  wax,  prepare  a  model,  and  then  press  the  gold 
foil  into  the  mould.  There  has  l)een  a  special  swaging  apparatus  made 
for  this  purpose,  but  none  of  these  aids  are  suited  to  give  up  such  an 
impression  as  we  can  obtain  by  following  the  method  which  I  am  about 
to  describe,  and  which  ensures  a  representation  of  the  cavity  which  is  in 
all  respects  accurate. 


28 


I  mention  first  the  invention  of  Dentist  Bruhn,  of  Uiisseldort,  who 
has  devised  Trial  Dies  by  which  the  gold  foil  may  be  given  a  shape 
approaching  that  required  before  it  is  pressed  into  the  cavity.  The  appa- 
ratus consists  of  a  rubber  cushion  upon  which  the  goldfoil  is  laid.  We 
then  select  from  the  assortment  of  twenty-five  stamped  pieces  of  metal 
that  which  conies  nearest  in  shape  to  the  cavity  to  be  filled,  screw  it  upon 
a  handle  and  press  the  stamp,  as  shown  in  Fig.  27,  lightly  upon  the  gold 
on  the  rubber  cushion.  The  superfluity  of  goldfoil  which  might  be  in 
the  wav  of  taking  or  withdrawing  the  impression  may  then  be  cut  away 
with  scissors.     I  am  convinced  that  this  apparatus  could  render  good  ser- 


Fig.  26. 


vice  to  beginners.  For  the  skillful  it  is  not  necessary.  As  1  have  already 
said,  by  continued  practice  one  may  acquire  great  skill  in  the  manipulation 
necessary  to  take  impressions,  though  at  first  the  difficulties  seem  great.* 

We  attain  the  end  arrived  at  with  Bruhn's  Trial  Dies  in  a  manner 
much  simpler  by  shaping  the  goldfoil  to  the  required  form  while  held 
in  the  hand  (Fig.  29)  with  a  pear  shaped  instrument  (Fig.  28). 

The  goldfoil  Nos.  30  and  40,  used  for  impressions,  may  be  kept  on 
hand  cut  to  various  sizes,  thus  avoiding  loss  of  time  in  this  time-consuming 
work.  The  foil  most  to  be  recommended  for  this  purpose  is  that  of 
Williams  or  White.  Williams's  is  somewhat  tougher  and  does  not  tear 
so  easily.     Beware  of  using  foil  to  which  particles  of  Paris  red  used  for 


'Another  apparatus  similar  to  Bruhn's  has  recently  been  constructed,  which  includes  a 
number  of  circular  knives  for  cutting  out  round  pieces  of  goldfoil.  The  high  price  of  this  appa- 
ratus will  probably  preven':  its  coming  into  gereral  use,  especially  in  view  of  the  fact  already 
stated  that  it  becomes  superfluous  on  the  acquirement  of  greater  skill. 


29 

polishing  still  cling.  Fillings  melted  in  such  foil  often  take  on  a  reddish 
tinge,  especially  at  the  edges,  which  may  destroy  the  success  of  the  filling. 
For  smaller  cavities  the  thinner  foil,  for  larger  the  thicker  is  recom- 
mended. Various  materials  may  be  used  for  pressing  the  foil  against  the 
walls  of  the  cavity,  for  example,  cotton,  soft  erasing  rubber,  unvulcanized 
caoutchouc,  soft  chamois  leather  and  spunk ;  for  the  most  part  I  use 
spunk,  cut  to  various  sizes,  and  sometimes  small  round  pieces  of  chamois 
leather  cut  out  with  a  punch   (Fig.  30). 


Fig.   29. 


D 


Fig.    30. 


Fig.   2S. 

Place  the  already  partly  moulded  piece  of  foil  in  the  cavity  with 
the  pliers  and  hold  it  steady  upon  the  deepest  part  with  a  piece  of  spunk.* 

To  beginners  we  especially  recommend  that  in  taking  difficult  impres- 
sions they  make  sure  by  the  removal  of  the  first  piece  of  spunk  that  the 
gold  is  so  placed  that  the  edges  will  not  be  drawn  into  the  cavity  by  the 
pieces  subsequently  introduced.  This  will  surely  happen  if  the  foil  has 
been  cut  too  small  or  if  it  be  not  properly  laid  in  the  cavity.  During  the 
ivhole  time  of  taking  the  impression  one  holds  in  place  zvith  a  blunt  instru- 


*In   cutting  up   the   spunk   reject  all   but  the   softest    pieces.     For   taking   impressions   only   the 
softer    sorts   should   be   used;    a   hard   piece   may  render  the  impression  unfit   for  use. 


30 


incut,  held  in  the  left  hand  (Fig.  31), 
the  pieces  of  spunk  already  placed  in 
the  cavity,  taking  constant  care  that 
the  foil  does  not  He  pressed  upon  the 
edges  of  the  cavity,  which  would  cer- 
tainly result  in  its  being  torn.  For 
putting  in  the  pieces  one  may  use  any 
pliers  not  too  pointed  unless  one 
chooses  to  get  those  made  for  this  pur- 
pose by  Dr.  Keyes  (seen  in  Fig.  32 
from  the  front  and  in  Fig.  33  from  the 
side),  which  is  provided  with  buttons 
that  form  a  small  ball  \\hen  the  instru- 
ment is  closed  and  which  prevent  pierc- 
ing the  goldfoil. 

Continue    to   fill   the   cavity    with 
spunk  without  exerting  nuich  pressure 


Fig.  34. 

near  the  edges.  When  the  cavity  ex- 
tends far  under  the  gum  and  especially 
in  approximal  cavities  it  is  well  to  cut 
the  goldfoil  in  the  shape  given  in 
Fig.  34.  bending  the  upper  edge  a 
and  laying  a  piece  of  soft  chamois 
leather  in  the  bent  edge  and  placing 
them  together  between  the  teeth  (Fig. 
35).  This  will  prevent  the  goldfoil 
from  being  drawn  into  the  cavity. 
Now  take  away  the  chamois  skin  to 
convince  yourself  that  the  goldfoil  is 
ill  the  right  position  and  proceed  to  fill 
with  spunk  as  above  described.  When 
the  cavity  is  full  the  next  step  is  to  press 
Fig.  31.        Fig.  82.        Fig.  33.  the  Overlapping  goldfoil  upou  the  cdges 

of  the  cavity.  On  this  point  I  would  re- 
mark that  it  is  of  great  importance  for  the  melting  to  retain  as  much  as  pos- 
sible of  the  foil  in  order  to  hair  during  the  melting  a  good  idea  of  the  situa- 


31 


tio)i  of  the  caz'ity  in  tJic  tooth.  However  there  must  not  be  retained  so  broad 
a  margin  of  foil  as  to  interfere  with  the  removal  of  the  impression  from 
the  cavity.  For  compressing  the  foil  over  the  edges,  which  is  not  to  be 
done  until  it  has  been  closely  pressed  against  the  interior  walls  by  filling 
the  cavity  with  spunk.  I  have  constructed  six  instruments  which  are 
sufficiently  adapted  to  the  requirements  of  every  cavity. 

The  cuts  give  both  front  and  side  views  of  these  instruments.  That  in 
Fig.  37  is  intended  for  all  large  labial  cavities :  38  for  smaller  labial  cavi- 
ties ;  39  and  40  for  approximal  cavities ;  41  for  cervical  cavities  :  42  for 
pressing  the  foil  into  fissures  of  bicuspids  and  molars. 


Fig.  35. 


Fig    36. 


These  instruments  are  to  be  used  with  a  light  rocking  movement, 
beginning  at  the  edges  of  the  cavity,  until  the  goldfoil  is  pressed  smoothly 
upon  the  tooth.  Fig.  43  shows  the  use  of  these  instruments  in  taking  an 
impression  of  an  approximal  cavity  in  a  bicuspid.  The  two  instruments 
marked  a  and  b  have  pressed  the  foil  against  the  palatal  and  buccal  walls ; 
the  instrument  c  presses  it  into  the  fissure  of  the  tooth. 

We  now  begin  the  removal  of  the  spunk.  With  a  pair  of  sharp  pliers 
we  take  out  one  piece  after  another,  those  remaining  in  the  cavitv  being 
still  held  firmly  with  an  intstrument.    If  in  spite  of  using  these  instruments 


32 

there  is  any  point  where  the  goldfoil  does  not  He  close  to  the  tooth,  which 
may  sometimes  occur  near  the  cervical  edge,  we  must  go  over  this  portion 
either  with  the  ball  pliers  or  with  the  ball  burnisher  (Fig.  45),  holding 
the  foil  meanwhile  with  a  blunt  instrument  at  some 
other  part  of  the  cavity  (Fig.  31 ).     For  an  impres- 


Fig.  3'J. 


Fig.  40. 


Fig.   42. 


Fig.   37.  Fig.  38. 


sion  of  a  cervical  or  labial  cavity  it  is  sufficient  to  press  with  one  of  the 
instruments  upon  the  spunk  which  fills  the  cavity.  The  foil  is  pressed 
down  upon  the  margins  by  the  elastic  rubber,  so  that  further  manipulation 
will  be  superfluous.     If  it  happens,  especially  in  approximal  cavities,  that 


33 


the  foil  is  too  large  at  the  cervical  edge,  or  that  in  the  case  of  front  teeth 
it  extends  too  far  over  the  palatal  wall,  so  that  it  would  be  difficult  to 
remove  the  impression  without  bending  it.  we  cut  away  the 

(superfluous  part  with  a  lancet  or  excavator,  taking  care  to 
keep  the  impression  in  place  by  holding  it  with  a  blunt  in- 
strument. 


Fig.  43. 

If    one    has    even    the    slightest    sus- 
picion that  the  goldfoil  has  altered  its  posi- 
tion in  any  respect,    it    is    well    to   press    it 
down  again  with  a  rather  large  piece  of 
spunk   to   make   sure   that   it  lies   closely 
against  all  parts  of  the  cavity.    Many  rec- 
ommend   taking    several    impressions    of 
every  cavity  and  the  melting  of  several  fillings.     Doubtless 
this  is  of  great  value  to  the  beginner,  since  by  this  means 
he  obtains  a  degree  of  skill  in  taking  impressions  and  in 
melting.     When,   however,   one   is   so    far   advanced   as   to 
succeed  with  almost  every  impression,  this  is  unnecessary. 
Of  course  it  will  sometimes  occur  when  the  cavity  is  difficult 
Fig.  45.  q£  access  that  the  first  filling  may  not  fit  as  perfectly  as 

desired,  but  the  repetition  of  the  process  in  such  a  case  will  not  consume 
so  much  time  as  that  required  for  several  impressions  and  meltings  for 
each  case. 


34 

Before  removing  the  impression  examine  care- 
K*iiO"7al  0-"  fully   with   the   lens   to  make   sure   that   the   foil    is 

the  Impression.        lying  closely  upon  all  the  edges  of  the  cavity. 

To  loosen  the  foil  I  have  for  a  long  time  made 
use  of  an  instrument  that  suits  all  cases.  It  is  White's  excavator  No.  97 
(Fig.  46).  In  labial  cavities  I  place  the  point  at  the  deepest  point  of 
the  impression,  when  a  light  lifting  movement  is  usually  enough  to  remove 


Fig.  46 


it.      In    approximal    cavities    in    the    front    teeth 

(Fig.  47)   I  place  the  point  of  the  excavator  at 

the   place   marked   a   and   try    to   draw    out   the 

impression  by  a  downward  motion,  as  indicated 

by  the  arrow ;  should  the  foil  not  loosen  at  the 

first  attempt,  I  continue  by  carefully  inserting  the 

instrument  between  tooth  and  foil,  beginning  at 

the  point  b,  until  the  loosened  condition  permits 

withdrawal  without  difficulty.     From  approximal 

cavities  of  molars  and  bicuspids  I  loosen  the  impression  both  on  buccal  and 

palatal  sides  (Fig.  48).     The  removal  of  the  foil  is  very  difficult  only  in 

cases  where  the  cavity  has  not  been  properly  prepared;  with  patience  we 

soon  learn  what  to  avoid  in  order  to  eflfect  the  removal  easily  and  without 

bending  the  foil  anywhere. 


Fig.   49. 


85 

The  method  proposed  by  Robicsek,  of  blowing  the  impression  out  of 
the  cavity  with  the  airblower.  is  not  to  be  recommended  on  account  of  the 
uncertainty  as  to  where  the  impression  may  hght  and  the  danger  of  its 
being  bent. 

If  rents  in  the  goldfoil  are  present  after  removal  from  the  cavity, 
they  will  not  affect  the  result  if  they  do  not  reach  too  near  the  edges. 
However,  it  is  well  to  aim  at  removing  the  impression  uninjured,  since 
rents  in  the  foil,  wherever  situated,  make  bending  more  possible  and 
require  more   careful  attention  during  the  fusing  process. 

The  best  implement  for  receiving  the  impression  is  the  mouth  mirror 
having  a  high  rim,  as  devised  by  Prof.  Sachs  (Fig.  49).  If  one  does  not 
proceed  immediatelv  to  the  melting,  the  celluloid  boxes  now  everywhere 
to  be  obtained  are  useful  to  protect  the  impression  from  injury. 

The  color  assortment   of   Dr.  Jenkins,   selected 
(Choice  of  Color.        from  many  hundred  shades  actually  tested  by  him, 
should  suffice  for  all  cases,  but  if  any  other  shade  be 
desired,  it  can  be  obtained  by  mixing  the  powders  furnished. 


^ 

~~^ 

:,iii 

1 I 

Fig.  50. 


In  regard  to  obtaining  good  results  in  color,  I  would  emphasize  one- 
piece  of  advice  that  I  have  already  given  in  my  article  on  "The  New 
Porcelain  Enamel  of  Dr.  Jenkins,"  which  appeared  in  1898,  viz. :  to  remove 
the  color  patterns  from  the  color  fans  and  to  replace  them  by  patterns 
made  by  oneself,  giving  each  sample  a  fourfold  fusing.  The  influence 
of  the  varying  heat  of  dift'erent  furnaces  upon  the  color  of  the  material 
differs  so  much  that  this  precaution  is  much  to  be  recommended. 

In  selecting  colors  take  for  all  labial  cavities  that  which  comes  nearer 
to  matching  the  tooth  ;  for  all  approximal  cavities  choose  a  somewhat 
lighter  shade.  When  I  come  to  speak  of  the  insertion  of  the  filling  I  shall 
take  occasion  to  show  what  modification  of  the  color  is  then  possible  in 
case  that  the  inlay  does  not  exacth-  match  the  tooth.  After  matching  the 
color  while  the  tooth  is  zvet,  if  the  filling  is  not  to  be  inserted  at  the  same 
sitting,  fill  the  cavity  with  gutta-percha,  first  removing  the  vaseline  or  olive 
oil  with  carbolized  alcohol. 

In  melting  contour  fillings  it  is  advisable  to  have  the  desired  form 
constantly  before  the  eyes.     Therefore  either  take  an  impression  of  the 


36 

oavitv  in  Stent's  conipouiul.  make  from  it  a  model  in  tine  plaster,  or  model 
the  contour  of  the  tootli  with  gutta-percha,  harden  with  cold  water  and 
remove.  While  melting  the  filling,  keep  this  model  before  the  eyes  to 
show  how  to  build  up  the  powder  in  order  to  perfect  the  contour. 

At  the  meeting  of  the  Central  Union,  held  at 
Caking  Impression,  Easter,  1901,  Dr.  Sachs  described  a  process  of  obtain- 
Dr.  Sachs's  method,  ing  a  good  impression  of  teeth  having  defects  of 
contour  which  I  should  not  leave  unmentioned.  Dr. 
Sachs  remarked  that  the  difficulty  in  the  case  of  such  teeth  was  not  so 
much  in  getting  good  impressions  as  in  building  out  the  porcelain — 
usuallv  for  missing  corners — to  the  proper  shape.  Even  when  one  is 
skillful  the  tooth  may  not  receive  the  proper  slant,  and  it  is  difficult  to 
give  the  corner  a  perfectly  natural  look,  if  the  work  is  guided  only  by 
the  judgment  of  the  eye.  It  is  therefore  desirable  to  secure  beforehand  a 
means  of  producing  accurately  the  desired  form.  Warming  a  piece  of 
Stent's  compound  the  size  of  a  walnut,  he  presses  it  from  the  palatal  side 
upon  the  tooth,  the  cavity  and  defective  part,  lets  it  cool,  and  then  cuts 
away  from  the  Stent's  compound  imtil  only  so  much  is  left  as  represents 
the  portion  of  the  tooth  that  is  to  be  replaced  by  porcelain.  Then  he 
takes  an  impression  with  goldfoil.  paints  the  Stent's  compound  model  over 
with  vaseline  and  presses  it  with  the  foil  into  the  cavity  so  that  the  gold- 
foil  outside  the  cavity  lies  closely  against  the  Stent's  compound.  The 
Stent's  compound  is  then  removed,  leaving  the  goldfoil  in  place,  which 
is  easilv  done,  as  the  vaseline  prevents  adhesion.  He  now  fills  the  hollow 
in  the  foil  with  wax  in  order  to  prevent  bending  the  goldfoil  on  removal, 
invests  in  a  mixture  of  plaster  and  asbestos,  washes  out  the  wax  and, 
putting  porcelain  powder  in  its  place,  proceeds  with  the  melting. 

Tnocstmcnt  of  tbe  Tmprcssion  ana  the  mcliittd  Process. 

1  will  now  speak  of  the  apparatus  used  in  the  preparation  of  porce- 
lain fillings.  Since  cleanliness  during  the  melting  process  is  a  chief  requi- 
site, it  is  advisable  to  have  a  special  table  reserved  for  porcelain  work, 
which  should  he  covered  with  sheet  tin  or  iron  and  upon  which  all  the 
necessary  instruments  and  apparatus  may  be  always  ready  for  use.  The 
bottles  which  hold  the  powder  must  be  kept  closed  against  dust ;  the 
spatula  and  brushes  used  for  putting  the  mixed  powder  into  the  impression 
must  always  be  carefully  cleaned  before  using.  In  the  middle  of  my 
work  table  I  have  an  electric  furnace  upon  a  stand  just  high  enough  to 
bring  the  opening  of  the  furnace  on  a  level  with  the  eyes.  There  is  also 
a  hermetically  closed  vessel  containing  asbestos  powder  mixed  with  alco- 


hoi;  a  bottle  of  alcohol  having  a  droptube.  a 
number  of  plates  upon  which  to  mix  the  pow- 
ders ;  pliers,  spatula  and  brush  ;  several  footles? 
wineglasses  for  covering  the  remnants  of  pow- 
der after  the  melting,  a  pair  of  colored  glasses 
to  shield  the  eyes  from  the  glow  of  the  furnace, 
and  the  box  of  powders. 

Dr.  Jenkins  has  constructed  a  small  plati- 
Tnccsting  num  cup  wdth  a  long  handle  (Fig.  51)   for  the 

tbc  matrix.  imbedding  of   the   impression,   which   one   fills 

with  the  asbestos  mixture,  placing  the  impres- 
sion in  it  with  the  pliers. 

I  do  not  mix  the  asbestos  with  water,  as  Dr.  Jenkins  recon> 
mends,  but  with  alcohol ;  for  it  is  my  experience  that  unless  the 
greatest  care  is  observed  in  the  drying  process  the  conversion  of  the 
water  into  steam  causes  the  lifting  up  of  the  goldfoil,  and  the 
impression  obtained  with  so  much  painstaking  is  bent  and 
spoiled. 

One  must  take  care  in  imbedding  the  impression  that  the  under 
side  next  to  the  asbestos  be  everywhere  supported  by  the  paste, 
which  may  be  usually  brought  about  by  gently  tapping  the  cup  on 
the  table,  but  in  manv  cases,  especially  in  complicated  approximal 
filings,  we  must  draw  some  of  the  paste  from  the  edge  of  the  cup 
with  a  spatula  (Fig.  52),  pushing  it  under  the  impression  until  sure 
that  all  hollow  places  are  filled.  There  is  another  small  aid  which 
we  may  not  despise,  since  such  are  often  very  important  for  the 
final  success  of  the  filling.  In  most  cases  sufficient  goldfoil  has 
been  retained  to  show  clearly  the  shape  of  the  tooth  and  the  sur- 
rounding parts.  The  superfluous  goldfoil  having  been  pressed 
closelv  against  the  tooth  pictures  the  situation  of  the  cavity.  We 
should  imbed  the  matrix  in  such  a  manner  that,  as  far  as  possible, 
we  may  have  the  cavitv  before  the  eye  in  the  melting  cup  in  the 
same  relative  position  that  it  occupies  in  the  tooth ;  we  shall  thus 
in  most  cases  avoid  putting  in  too  much  powder.  Fig.  53  shows 
the  prepared  cavity.  In  Fig.  54  the  foil  lies  over  the  edges  in  such 
a  way  that  it  may  be  easily  removed  and  will  give  an  almost  perfect 
representation  of  the  tooth.  In  Fig.  55  the  position  of  the  cavity 
and  the  shape  of  the  tooth  can  easily  be  recognized  from  the 
imbedded  gold. 

When  the  impression  is  properly  placed  in  the  asbestos,  ignite 
the  alcohol  contained  in  the  asbestos  paste  and  let  it  burn  away 
completely.     It  will  often  happen  that  some  of  the  paste  has  flowed 


Fig.   51. 


38 


into  the  impression,  perhaps  through  a  rent  at  the  bottom,  and  dried 
on  by  the  burning  out  of  the  alcohol.  It  can  best  be  removed  by  a  brush 
wet  with  alcohol. 

Place  the  probable  quantity  of  porcelain  powder 

Tillins  required  for  the  filling  upon  the  agate  plate  furnished 

the  matrix.  with  the  Jenkins  apparatus  and   mix  with  absolute 

alcohol  to  a  thin  paste  of  cream-like  consistency.* 
In  mixing  the  porcelain  powder  with  alcohol  take  great  care  that  it 
be  kept  free  from  dust,  threads  or  other  impurities,  since  the  smallest 
particles  of  dust  may  afifect  unfavorably  the  color  of  the  filling.  After 
moistening  the  foil  with  a  drop  of  alcohol,  fill  the  impression  to  the  edge 
with  the  porcelain   paste,   which  may  be   done  with  the  spatula  recom- 


Fig.    53. 


Fig.    54. 


mended  by  Dr.  Jenkins,  or,  as  I  prefer  after  long  experience,  with  a  very 
small,  finely  pointed  camel's  hair  brush.  If  the  alcohol  evaporates  before 
the  impression  is  filled,  moisten  the  paste  again. 

The  important  point  in  filling  the  impression  is  that  the  paste  should 
fill  it  perfectly  everywhere,  so  that  there  be  no  hollow  places  beneath  which 
can  cause  bubbles  in  the  melting.  We  make  sure  of  this  by  letting 
alcohol  drop  into  the  impression  from  the  droptube  held  in  the  left  hand, 
while  with  a  l)rush  in  the  right  hand  we  gently  manipulate  the  paste 
until  it  is  thoroughly  distributed  to  every  part  (Fig.  56).  We  are  also 
careful  not  to  put  too  vinch  paste  at  a  time  into  the  impression.  The 
asbestos,  as  well  as  the  porcelain  powder,  should  now  be  dried  by  burning 
out  the  alcohol  before  the  fusing  process  begins. 

For  this  process  Dr.  Jenkins  has  constructed  two 

Che  Turnaccs.         similar  pieces  of  apparatus,  one  for  gas  and  the  other 

for  alcohol,  this  latter  for  the  use  of  those  who  have 

not  at  command  either  gas  or  electricity.     With  the  introduction   of  the 


*Dr.  Jenkins  strongly   advises  against   mixing    norcelain-enamel  with   alcoliol  on  glass,   lest  par- 
ticles  of  glass  become  mixed   with   the   powdei. 


39 

alcohol  furnace  the  last  obstacle  has  been  removed  which  in  some  local- 
ities prevented  the  introduction  of  Dr.  Jenkins's  method.  Besides  these 
two,  the  Mitchell  electric  furnace  (Fig.  57)*  can  be  advantageously  used 
for  melting  the  Jenkins  fillings.  I  have  myself  used  it  for  two  years 
with  the  best  results. 

The  Jenkins  gas  furnace  (Fig.  58)  consists  of  an  asbestos  lined 
mufifel,  with  an  adjustable  support,  open  in  front  and  with  an  opening 
in  the  floor  through  which  the  flame  enters.  This  is  fastened  to  a  base 
to  which  are  also  fixed  the  pipes  for  air  and  gas  and  the  regulating  device 


Fig.    55. 


for  the  latter.  To  the  stand  are  fixed  an  arm  for  supporting  the  handle 
of  the  melting  cup  and  a  shield  of  colored  glass  for  the  protection  of  the 
eyes.  There  belongs  also  to  the  apparatus  a  standing  IdcHows  connected 
with  the  blowpipe. 

The  alcohol-gas  furnace  (Fig.  59)  varies  but  little  from  the  one 
just  described,  the  principal  difference  being  that  the  gas  necessary  for 
use  in  fusing  must  first  be  made  in  the  small  retort  at  the  right  of  the 
apparatus. 

The  process  is  thus  described  by  Dr.  Jenkins:  "The  alcohol  holder 
after  removal  of  the  screw  a  is  filled  with  absolute  alcohol  and  the  screw 
replaced.  The  valve  b  is  only  a  safety  valve  and  the  alcohol  is  on  no 
account   to  be  poured   through  it.     The  lamp  d  is  filled  with   ordinary 


*  Unfortunately  this  electric  furnace  has  the  disadvantage  of  not  being  durable.  Repairs  are 
frequently  necessary  on  account  of  the  burning  out  of  the  wires,  making  it  needful  to  have  a 
duplicate  on  hand  in  order  not  to  be  left  in  the  lurch. 


40 


alcohol  through  the  opening  c,  behind  the  holder,  which  is  covered  with 
a  cap.  Then  the  lamp  d  is  lighted  and  the  flame  regulated  by  screwing 
the   wick  up  or  down.     In  a   few   minutes  the  absolute  alcohol   in  the 


Fig.   56. 


Fig.  57. 


holder  above  the  lamp  will  be  sufficiently  heated  and  the  gas  will  find 
its  way  through  the  burner  e.  The  products  of  condensation  are  carried 
into  the   receptacle  g.     As   soon  as  the  first  drops  fall  into  it,   we  can 


41 


light  the  burner  e.  The  contents  of  g  can  be  used  for  replenishing  the 
lamp.  The  standing  foot  bellows  is  connected  with  the  tube  /  and  a 
flame  obtained  that  can  only  be  blown  out  by  a  violent  use  of  the  bellows. 
This  flame  can  be  regulated  as  desired  bv  regulation  of  the  lamp  d." 


In  using  either  of  these  furnaces  for  fusing  fillings,  one  covers  the 
melting  cup  with  a  nickel  cap  which  has  an  opening  through  which  the 
melting  process  can  be  closely  watched  (Fig.  51).  We  note  here  that 
the  melting  requires  a  longer  time  in  the  alcohol  gas  furnace  than  in 
the  other. 


42 


Mitchell's  electric  furnace,  which  i  use  exclusively  in  the  fusing  of 
porcelain  fillings,  consists  of  a  small  box  having  an  iron  support.  In 
the  middle  of  the  box  is  an  opening  ilA  cm.  square.     The  interior  of  the 


Fig.  59. 


box  is  filled  with  an  asbestos  composition  in  which  platinum  wires  are 
imbedded.  Through  connection  with  the  electric  current  these  wires  and 
the  mass  of  asbestos  are  brought  to  a  glowing  heat. 


43 


In  order  to  prevent  as  far  as  possible  the  burning  out  of  the  wires, 
which,  as  I  have  already  mentioned,  often  happens  in  constant  use  of 
the  furnace,  I  have  had  a  switch  arranged  close  to  my  work  bench 
so  that  when  for  a  moment  or  two  the  furnace  is  not  actually  in  use,  as 
while  the  filling  is  cooling  or  I  am  adding  more  powder,  I  can  at  once 
shut  ofif  the  current.  By  observing  this  precaution  the  repairs,  so  fre- 
quent previously,  have  become  rarer. 

In  the  Jenkins  gas  furnace  the  regulation  of  the  intensity  of  the  heat 
is  brought  about  by  an  adjustment  of  the  valve  of  the  blowpipe  to  a 
scale   with   millimeter   divisions ;   and   in   the   alcohol    furnace  by   raising 


Fig.   60. 

or  lowering  the  position  of  the  lamp,  while  in  the  electric  furnace  we 
effect  the  same  object  by  breaking  the  current  as  already  mentioned, 
resulting  in  the  more  gradual  increase  of  the  heat,  or  by  introducing  a 
rheostat  into  the  circuit. 

The  question  has  lieen  much  debated  whetlier  when  practicable  one 
should  use  the  electric  furnace  in  preference  to  the  Jenkins  furnaces.  For 
my  own  part,  as  above  stated,  I  use  only  Mitcheirs  electric  furnace,  which 
with  a  properly  regulated  current  has  the  same  advantages  as  the  two 
Jenkins  furnaces  and  seems  to  me  to  have  an  essential  advantage  in 
respect  of  uniformity  of  heat  and  of  the  flowang  of  the  porcelain.  ]\Iore- 
over,  the  fillings  can  be  fused  in  a  shorter  time,  which  to  a  busy  man 
means  a  considerable  saving.  The  same  results,  some  say  better  results, 
can  be  obtained  with  the  other  two ;  in  small  places,  where  electricity 
cannot  be  had.  the  question  need  not  come  into  consideration. 

In  using  the  electric  furnace  (there  are  others  besides  the  Mitchell 
on  the  market)  it  is  not  necessary  to  cover  the  impression  with  the  nickel 


44 


cap,  since  no  soot  is  formed  in  an  electric  furnace,  an  advantage  deserving 
consideration. 

A  slight  change  must  be  made  in  the  shape  of  the  melting  cup  for 
use  in  the  electric  furnace.  Cut  ofT  the  cup  and  wire  from  the  handle, 
hammer  the  wire  flat  and  bend  it  to  the  shape  shown  in  Fig.  60.  As 
the  cup  does  not  correspond  in  size  with  the  opening  of  the  furnace,  the 
sides  may  be  bent  a  little  to  admit  of  its  being  easily  passed  in  and  out. 

The  process  of  melting  is  the  same  with  all  these 

methods  Of  furnaces.    Usually  three  or  four  fusings  are  suf^cient, 

fusing.  but  in  making  large  contour  fillings  a  greater  number 

are  sometimes  necessary. 

For  the  first  melting  fill  the  impression  to  the  edge  with  the  porcelain 

powder    (Fig.  61),  but  do  not  let  it  fuse  entirely;  but  as  soon  as  you 


Fig.   61. 


Fig.    62. 


see  that  the  mass  has  contracted  and  run  together  remove  from  the  fur- 
nace. At  this  stage  the  surface  of  the  porcelain  is  rough  and  has  the 
appearance  of  a  biscuit ;  although  the  impression  was  filled  to  the  edges 
with  powder,  it  has  now  so  contracted  that  the  bottom  is  scarcely 
covered  (Fig.  62). 

Dip  the  bottom  of  the  cup  in  water,  to  cool  it,  taking  care  that  no 
water  gets  into  the  cup. 

Then  with  the  drop  tube  let  alcohol  flow  upon  the  filling  from  the 
edges — not  fall  directly  upon  the  tilling — and  add  more  powder  paste, 
pushing  it  with  the  brush  into  all  the  little  depressions.  For  this  purpose 
the  consistency  of  the  paste  should  be  very  thin.  When  certain  of 
having  filled  in  the  paste  wherever  needed,  we  let  one  drop  of  alcohol 
fall  directly  upon  the  impression,  then  fill  up  to  the  edges  again  with 
paste,  burn  out  the  alcohol,  and  fuse  a  second  time. 


45 


We  now  hold  the  melting  cup  so  long  in  the  flame  that  the  mass 
becomes  thoroughly  fused  and  the  surface  smooth  and  shining. 

Fig.  63  shows  the  filling  after  the  second  fusing.  The  porcelain 
enamel  has  now  attached  itself  to  the  edges  in  two  places,  above  and 
below,  but  on  either  side  it  has  drawn  away.  These  places,  after  cooling 
the  cup,  must  be  filled  out  as  before  described.*  Now  follows  the  third 
fusing.  By  turning  the  cup  during  the  melting  one  can  direct  the  flow 
of  the  porcelain  towards  any  point  desired.  In  the  electric  furnace  we 
can  set  the  cup  aslant  on  the  wall  and  attain  this  end  more  easily  than 
with  the  other  furnaces,  where  the  cup  is  held  in  the  hand. 

After  the  third  fusing  in  most  cases,  especially  after  a  degree  of 
skill  has  been  acquired,  the  filling  will  be  finished.  It  is  better  in  the 
beginning  to   use   less  powder  at   a  time  and  melt   once   or  twice  more 


Fig.   63. 


Fig.   64. 


rather  than  make  the  filling  too  high  and  be  obliged  to  grind  off  some- 
thing from  the  filling  after  it  is  set. 

Fig.  64  shows  a  perfect  filling  after  three  fusings.  I  could  judge 
just  how  much  powder  to  put  in  to  obtain  the  desired  height  of  this 
filling  because  I  had  in  the  imbedded  impression  the  exact  representation 
of  the  position  of  the  cavity  in  the  tooth.  I  would  again  emphasize  this 
point.  Allow  so  much  of  the  goldfoil  to  overlap  the  edges  of  the  cavity 
that  you  have  this  relative  position  before  your  eyes  while  melting  and 
so  may  be  able  easily  to  determine  what  quantity  of  powder  to  add  to 
make  a  perfect  contour. 

I  now  call  attention  to  another  use  of  the  Jenkins 

Us?  Of  Gum  powder.     We  often  have  occasion  to  fill  front  teeth 

Colored  Porcelain,      whose  defects  not  only  extend  under  the  gum,  but 

also,     on     account    of    the     recession    of    the   gum, 

•Dr.  Hirschfeld  recommends  comparing  the  chosen  sample  on  the  fan  with  the  piece  in  the 
melting  cup  before  the  third  melting,  in  order,  if  the  match  be  not  perfect,  to  employ  a  different 
shade  for  the  final  fusing. 


46 


require  a  more  complicated  restoration.  Fig.  65  shows  such  a  tooth.  For 
that  part  of  the  fiUing  which  is  to  supply  the  place  of  the  normal  gum 
tissue  we  can  best  use  the  gum  colored  porcelain  powder  supplied  in  the 
Jenkins  outfit. 

Fig.  66  represents  this  tooth  filled  with  porcelain  enamel,  the  gum 
being  restored  in  form  and  color  by  the  use  of  th.e  rose  tinted  powder, 
giving  the  tooth  its  natural  appearance. 

If  in  such  cases  the  defects  are  very  small,  and  yet  from  their 
position  at  the  necks  of  the  teeth  it  is  desirable  to  use  the  gum  color  for 


'# 


Fig.  65. 


i-ig.  66. 


Fig.   67. 


appearance  sake,  it  is  recommended   to  make  the  tirst  melting  of  some 
other  color  and  flow  the  gum  color  over  it. 

Although  the  Jenkins  Enamel  can  be  readily  ground  away  and 
beautifully  polished,  yet  by  doing  this  we  sacrifice  the  original  lustre 
obtained  in  melting  which  no  polishing  can  restore. 

The  melting  process,  represented  in  Figs.  61  to 

Tusing  for  64,  is  very  simple ;  it  is  much  more  difficult  when  we 

Contour  Tillings.       have  contour  fillings   to  make.     In   such   cases  one 

must  take  care  in   flie  second   melting  not  to  allozv 

the  poivder  to  floiv  to  the  edges.     Melt  as  shown  in  Fig.  67,  by  layers, 

in  order  to  prevent  the  mass  from  flowing  over  the  edges.     First  melt  in 

the  shape  of  a  flat  ball  at  the  bottom  of  the  impression,  adding  successive 

layers :  although  the  cut  shows  this  only  schematically,  yet  it  is  a  plan  that 

can  be  very  nearly  effected  in  practice.     In  melting  we  build  the  powder 

up  higher  than  the  real  contour  requires ;  it  flows  in  the  direction  indicated 

by  the  arrows,  so  that  we  obtain  just  the  desired  contour.     I  mentioned 

in  describing  the  taking  of  the  impression  that,  in  order  to  have,  while 

melting,  a  certain  guide  as  to  the  form  and  size  of  the  piece  to  be  built 

out,  one  should,  after  removing  the  goldfoil.  model  in  gutta  percha  upon 


the  cavity  the  desired  restoration,  harden  this  model  and  keep  it  before 
him  that  he  may  know  exactly  where  to  place  the  porcelain  powder  during 
the  fusing  process.  By  following  this  method  we  avoid  building  out  the 
contour  in  a  false  direction,  a  misfortune  which  cannot  be  remedied  after 
the  filling  is  finished.  The  more  carefully  one  goes  to  work  at  the  begin- 
tiing  of  the  melting  process,  the  more  successful  he  will  be.  To  become 
thoroughly  familiar  with  all  the  properties  of  the  material  and  the  several 
stages  of  the  fusing  process  by  previous  practice  is  of  course  essential. 

V. 

Cbc  Preparation  of  ;€apitie$  and  of  the  Completed  Tillings  for  Insertion  and 

fastening  in  Position. 

On  completion  of  the  melting  process  we  let  the  porcelain  cool  off 
and  then  dip  it  in  cold  water;  this  last  for  the  purpose  of  more  easily 
detaching  the  goldfoil.  With  the  tweezers  we  cautiously  separate  the 
foil  from  the  filling,  beginning  at  the  edges,  which  we  must  avoid  injuring. 
This  can  usually  be  accomplished  without  difficulty ;  if,  however,  as  some- 
times happens,  the  foil  does  not  come  away  in  one  piece,  but  remains 
partially  clinging  to  the  reverse  of  the  filling,  we  remove  these  bits  with 
an  excavator.  The  filling  when  ready  for  insertion  should  be  entirely  free 
from  particles  of  gold. 

If  there  has  been  a  rent  in  the  impression,  we  look  for  the  place  where 
the  porcelain  has  united  with  the  asbestos  while  fusing.  This  is  readily 
discovered  as  a  rough  excrescence  which  is  to  be  removed  with  a  corundum 
stone,  since  otherwise  the  filling  may  not  fit  the  cavity. 

We  now  place  the  piece  in  the  cavity  to  ascertain  by  examination  with 
the  lens — in  cases  where  the  cavity  extends  to  the  palatal  surface  by  help 
of  the  mouth  mirror — if  it  fits  the  margins  closely  at  every  point. 

Though  we  may  hold  large  fillings  in  the  pliers,  it  is  often  impossible 
in  the  case  of  small  ones.  We  can  manage  by  using  a  broken  plugger  with 
the  rough  end  dipped  in  mastic.  It  is  well  to  lay  a  saliva  apron,  or  towel, 
about  the  patient  while  handling  the  filling,  to  avoid  dropping  the  filling 
on  the  floor  and  thereby  losing  much  time  in  hunting  for  it. 

The  next  item  of  procedure  is  to  provide  the 

Undercuts  cavity  with  undercuts  for  the  retention  of  the  filling. 

in  Cavity.  Since  the  making  of  undercuts,  especially  in  labial 

cavities  in  front  teeth,  is  often  painful,  on  account 

of  the  nearness  of  the  pulp,  it  is  well  to  use  an  obtundent,  such  as  menthol 

in  absolute  alcohol,  in  the  proportion  of  2    :  i,  Validol  camphoratum  or 

pure  carbolic  acid. 


48 

In  every  case  use  i-cry  sJiarp  instntiiieiits  and  dry  out  carefully 
beforeluind  with  hot  air. 

For  making  undercuts  use  either  rose  or  wheel  hurs.  Do  not  make 
them  too  near  the  margin.  l)ut  more  towards  the  bottom  of  the  cavity; 
when  the  filHng  fits  well  it  is  enough  that  it  has  a  good  hold  at  its  base. 

The  filling  must  also  be  furnished  with  several 

Undercuts  undercuts,    made    to    correspond,    when    practicable, 

in  Tillings.  with  those  in  the  cavity,  thus  forming  a  ring  which 

filled  with  cement  will  surround  the  filling  and  give 

secure  hold.     Fig.  68  shows  a  section   of  a  tooth   filled   with  ])orcelain 

where  the  undcrcr.ts  correspond  as  aforesaid. 


oo 


J-ig.   70. 


<2=^ 


Fig.  71. 


Fig. 


For  making  undercuts  in  the  porcelain,  thin  nickel  disks,  of  various 
sizes,  covered  with  diamond  dust,  are  used  (Fig.  69).  Those  made  by 
Ash  &  Sons  are  the  best  for  this  purpose,  being  more  durable  than  other 
makes ;  but  it  is  important  to  keep  the  disk  wet  while  in  use,  since  other- 
wise they  become  useless  at  once. 

The  undercuts  in  the  filling  should  also  not  be  made  too  near  the 
edge,  or  the  filling  may  break  under  the  pressure  of  forcing  it  to  place, 
though  ever  so  moderately  applied. 

There  are  three  kinds  of  undercuts  used  for  the  filling,  the  most 
common  being  a  groove  encircling  the  piece  (Figf.  70)  ;  for  specially  large 


49 


fillings,  as  in  the  building  out  of  contours,  several  parallel  grooves 
(Fig.  71)  ;  and,  lastly,  the  cutting  out  the  center  of  the  tilling,  as  shown 
in  Fig.  'J2,  a  method  adopted  for  flat  fillings. 

There  are  other  ways  of  making  retaining  points.  For  example : 
Erich  Schmidt,  of  Berlin,  lays  bits  of  copper  wire  at  the  bottom  of  the 
impression,  melts  them  into  the  porcelain  and  afterwards  dissolves  out 
the  copper  by  boiling  in  nitric  acid. 

In  my  opinion,  the  cuts  made  with  the  diamond  disk  give  greater 
security  to  the  filling.  In  order  to  make  them  one  holds  the  bit  of 
porcelain  with  thumb  and  finger  of  the  left  hand,  having  previously 
moistened  and  dipped  them  in  pumice  powder  to  prevent  slipping,  and  cuts 
the  groove  with  the  diamond  disk  in  the  engine,  using  as  little  pressure  as 


possible.  In  Fig.  j^,  I  have  attempted  to  show  the  manner  of  holding 
filling  and  disk,  the  position  of  course  constantly  varying  with  the  progress 
of  the  cutting. 

After  making  the  undercuts  wash  the  filling  carefully,  dry  with  a 
napkin  and  hold  it  over  an  alcohol  flame  to  make  sure  that  no  moisture 
is  left  in  the  undercuts.  It  may  happen  that  too  quick  heating  of  the 
porcelain  may  crack  it;  in  which  case  one  can  take  a  new  impression  of 
the  cavity,  lay  the  broken  pieces  into  it,  and  remelt.  Since  some  of  the 
material  has  been  cut  away  in  making  undercuts,  it  will  be  necessarv  to 
add  some  porcelain  powder  before  melting  to  ensure  the  original  height 
of  the  filling.     The  advantage  of  this  is  that  it  saves  a  threefold  melting. 

The  filling  is  fastened  into  the  tooth  with  cement. 

Setting  Those  cements  should  be  used  which  have  the  finest 

the  Tillinfl.  possible  powder  and  which  do  not  harden  too  quickly. 

Dr.  Jenkins  has  had  a  cement  made  expressly   for 

setting  his  fillings ;   it  is  specially   manufactured  by  the   makers  of  the 

Harvard  Cement  in  Berlin.     For  a  year  and  a  half  I  have  used  successfulk 

S.  S.  White's  Alphos  Cement. 


oil 


If  on  tryiiii;-  in  Uk'  tilling  one  tinds  it  too  light  ur 
too  dark,  it  can  he  partially  remedied  by  using  respec- 
tively a  darker  or  lighter  cement,  sometimes  by  mixing 
the  phosphate  powders.  The  mixing  of  the  cement 
requires  the  most  thorough  incorporation  of  the  pow- 
der and  fluid,  since  the  smallest  lump  in  the  cement  will 
cause  failure.  The  consistency  of  the  cement  must  be 
that  of  cr-am,  but  on  no  account  thinner,  or  it  will  not 
harden  with  sufificient  strength  for  permanency. 

Put  a  small  quantity  of  cement  into  the  cavity  ancl 
distribute  it  into  the  undercuts  with  a  suitable  instru- 
ment. I  use  for  the  purpose  the  one  represented  in 
Fig.  74.  Then  with  a  small  and  thin  spatula  (Fig.  75) 
fill  the  undercuts  in  the  porcelain  filling  with  cement 
and  set  it  in  place.  I  give  here  a  useful  hint,  and 
illustrate  with  the  example  shown  in  Fig.  76.  Put  in 
first  that  side  of  the  filling  which  lies  near  the  cutting 
edge  and  press  gradually  to  place,  so  that  the  super- 
fluous cement  may  be  pushed  out  before  the  filling 
in  the  direction  of  the  arrow.  By  so  doing  one  pre- 
vents the  lifting  of  the  filling  by  any  air  that  may  have 
remained  in  the  cavity. 

It  is  not  necessary  to  use  a  great  quantity  of 
cement  in  the  insertion  of  a  filling.  It  suffices  to  fill 
the  undercuts  and  to  have  enough  that  a  little  overplus 
be  visible,  oozing  out  at  the  edges  of  the  filling.  Thi> 
overplus  is  removed  with  a  narrow  linen  tape  (Fig.  yy). 
The  filling  is  then  held  firmly  in  place  with  a  fiat  piece 
of  hickory  wood  (Fig.  78)  until  the  cement  begins  to 
harden.* 

Dr.  Green,  of  Albany,  recommended  in  the  Inter- 
national Dental  Journal,  1896,  to  warm  the  filling  jusr 
before  insertion.  I  have  tried  it  several  times  and 
cannot  too  strongly  warn  against  doing  so,  since  it 
causes  the  cement  to  harden  before  one  can  bring  the 
filling  into  the  proper  position. 

It  is  best  not  to  remove  the  rubber  dam  or  moulh 
napkin  until  the  cement  left  on  the  mixing  plate  is  quite 
hard.  If  obliged  to  admit  saliva  sooner,  melt  over  the 
filling   and    margins    a    thin    coat    of    paraffine    under 


*A    very    important    requirement,    too    often     not   observed. — Editor. 


J 

Fig.    74. 


lig.   75. 


51 


which  the  hardening  process  will  continue  undisturbed.  I  cover  all  fillings 
with  such  a  layer  of  paraffine,  which,  with  the  remaining  particles  of 
cement,  is  afterwards  removed  by  the  patient  in  the  act  of  brushing. 

With  practice  one  will  rarely  make  a  filling  that  does  not  exactly  fit 
the  cavity.  Should  it  happen,  however,  that  a  filling  is  too  high,  or  that 
the  porcelain  has  flowed  over  the  edges,  one  can  remove  the  superfluous 
part  with  corundum  stones  and  sandpaper  disks  (if  one  does  not  prefer 
to  make  a  new  filling)  either  before  or  after  setting  in  place ;  in  the  latter 
case  after  a  day  or  two.  For  polishing  the  surface  roughened  by  this 
grinding,  use  sandpaper  disks  for  approximal  and  Arkansas  stones 
(Fig.  79)   for  labial  and  buccal  positions. 


Fig. 


In  concluding  this  part  of  the   subject,   I  must 

Scaling  contradict  the  statement  often  advanced  by  opponents 

the  Canity.  of  porcelain  fillings,  viz. :  that  a  porcelain  filling  never 

properly  seals  a  cavity,  since  there  is  always  a  space 

of  the  thickness  of  the  goldfoil  between  the  filling  and  the  walls  of  the 

cavity ;  the  cement  which  fills  this  space  must  soon  be  dissolved  by  saliva, 

leaving  the  tooth  unprotected  from  secondary  decay,  and  the  earlv  falling 

out  of  the  filling  is  inevitable.     Flow  mistaken  this   opinion  is  I  would 

show  by  means  of  the  three  following  illustrations: 

Fig.  80  shows  a  section  of  a  properly  prepared  cavity.  Fig.  81,  the' 
same  cavity,  in  which  is  laid  the  filling  still  enclosed  in  the  goldfoil 
impression.     (The  goldfoil  is  here  purposely  represented  thicker  than  it 


52 

actually  is.)     In  J-'ig.  i^j  the  goldfoil  is  i-enioved,  and  the  tilling  lies  in  the 
cavity  without  it. 

Although  on  account  of  the  thinness  of  the  goldfoil  there  is  no  space 
left,  worth  mentioning,  betzveen  the  ivalls  of  the  cavity  and  the  Ming, 
yet  since  in  the  case  of  properly  prepared  cavities  the  tillings,  after  the 
goldfoil  is  removed,  sink  deeper  into  the  cavity  to  an  extent  corresponding 
to  the  thickness  of  the  goldfoil,  this  space  consequently  disappears  entirely 
and  there  is  barely  room  left  for  cement. 


*if--j^'  fi-'-i^ 


Fig.  79. 


Fig.  80. 


Fig.    81. 


Fig.   89. 


In  order  not  to  kee]j  the  i:)atient  in  di.sconifort  from  the  rubber  dam 
while  the  cement  is  hardening,  one  can  draw  the  dam  over  the  tooth,  as 
shown  in  Fig.  83.  By  means  of  this  arrangement  the  patient  can  wait  in 
a  neighboring  room  while  the  operator  attends  to  another. 


VI. 

Application  of  the  "Porcelain  enamel"  of  Dr.  JenKlns  to  the  Restoration 
of  the  Cargcr  Defects  in  Ceetb. 

Beside  its  use  for  tillings  of  ordinary  size  and  form  and  for  restoring 
the  contour,  there  are  many  other  cases  in  which  porcelain  enamel  can  be 
employed,  such  as  defects  from  traumatic  causes  or  where  large  portions 
of  the  tooth  have  been  destroyed  by  decay. 

In  cases  where  formerly  the  only  method  possible  was  to  set  a  crown, 
the  same  or  even  better  results  mav  now  often  l)e  obtained  bv  the  u.se  of 


this  enamel.  Of  course  in  such  cases  one  must  carefully  take  into  con- 
sideration whether  the  bite  may  endanger  the  durability  of  the  work. 

//  the  bite  does  not  in  any  zuay  interfere,  one  can  replace  large 
portions  of  teeth  with  porcelain  enamel  tmthout  anxiety.  The  patient  will 
not  be  obliged  to  take  more  care  in  using  teeth  built  out  with  porcelain 
enamel  than  he  would  of  a  Richmond  crown,  which  we  often  use  in 
such  cases. 

Before  I  proceed  to  the  description  of  these  cases,  I  would  call 
attention  to  the  principle  that  in  this  work  the  depth  of  the  cavity  should 
nearly  correspond  to  the  size  of  the  contour  to  be  built  out,  in  order  that 
the  porcelain  may  have  a  firm  hold  (Fig.  84).  I  do  not  think  it  absolutely 
necessary  to  anchor  it  with  posts  or  stays;  indeed,  in  many  cases,  I  think 
their  use  disadvantageous  in  relation  to  durabilit} . 

From  the  many  cases  in  which  I  have  restored  large  defects  by  the 
use  of  porcelain  enamel  in  the  last  few  years.  I  select  only  the  following 
for  description  here. 


Fig.   84. 


The  locksmith's  apprentice,   F.,    fell   through  a 
€a$C  T.  glass  roof  and  broke  his  right  superior  incisor.    The 

pulp  was  exposed,  and  the  patient  experienced  great 
pain  on  opening  his  mouth.  He  came  to  the  Breslau  Dental  Institute 
and  was  sent  to  the  operative  department  under  my  supervision.  The 
fracture  ran  from  the  mesial  wall  rather  near  the  gum  obliquely  down- 
ward to  the  distal  wall.  The  first  thought  in  treating  so  great  an  injury 
was,  after  destroying  and  removing  the  pulp,  to  set  a  Richmond  crown, 
but  I  decided  against  it,  since  this  kind  of  fracture  did  not  demand  an 
operation  that  should  remove  the  whole  crown  to  the  root. 

At  the  first  sitting  by  using  Anestile  Benguc  I  removed  the  pulp, 
and  for  several  days  treated  the  pulp  canal  with  iodoforni-ether,  since 
the  shock  had  induced  a  slight  irritation  of  the  peridental  membrane.  1 
then  filled  the  root  canal  and  prepared  the  tooth  for  the  insertion  of  a 
large  piece  of  porcelain.     This  filling  has  now  been  in  place  over  a  year. 


54 

I'ig.  85,  from  a  photograph  not  retouched,  represents  tlie  outHne  of  the 
fining  and  inchoates  how  httle  it  shows  in  the  mcnitli. 

A   young  girl   of   14  came   under  my   care   for 

€a$C  IT.  treatment  of  the  right  superior  incisor,  destroyed  by 

decay,  as  shown  in  Fig.  86.     It  was  the  express  wish 

of  the  parents  not  to  liave  a  Richmond  crown,  so  I  was  obliged  to  see 

what  I  could  do  with  porcelain   enamel,   and   succeeded  extraordinarily 

well,  as  appears  from  h'ig.  87. 


Fig.  85. 


]"ig.   SG. 


Fig.  87. 


This  case  needed  the  restoration  of  a  front  tooth. 
6asc  TTT.  Jt  had  been  filled  with  cement  and  became  discolored. 

After  excavation  there  was  scarcely  anything  left  of 
the  labial  wall  but  the  enamel.  When  the  porcelain  filling  had  been  set, 
the  original  form  and  color  were  restored,  and  the  patient  is  able  to  use 
the  tooth  as  formerly.  I'ig.  88  and  89  show^  the  tooth  before  and  after 
treatment. 

This    patient    came    to   have    an    artificial    piece 

Case  lU.  made.    The  incisors  were  all  gone;  both  cuspids  were 

l)artially    destroyed    by    decay   proceeding    from    the 

points  and  had  been  filled  with  gold.     The  plate  which  the  patient  was 

wearing  had  been  constructed  in  relation  to  these  shortened  cuspids,  and 


the  appearance  of  the  short  teeth  was  unpleasing.  On  touching  the  gold 
finings  with  an  excavator,  I  found  them  ready  to  fall  out,  and  therefore 
removed  them  and  restored  hoth  cuspids  with  large  and  deeply  seated 
porcelain  fillings.  Now  that  the  cuspids  had  their  original  form,  I  could 
use  teeth  of  normal  size  in  making  the  new  denture.  In  this  case  I  had 
also  the  opportunity  to  use  porcelain  enamel  in  another  way.  In  trying 
in  the  piece  I  observed  that  the  root  of  the  left  upper  incisor  (that  of 
the  right  was  absent)  had  altered  its  position  in  the  course  of  time  and 
lay  inclined  towards  the  cuspid  in  such  a  way  that  a  part  of  it  came  into 
view  between  the  incisors  of  the  artificial  piece.  In  order  to  get  rid  of 
(his  lilemish,  I  fused  some  porcelain  enamel  No.  18  (gum  color)  into  the 


t 


Fig.   88.  Fig.    89. 


Fig    90 


space  between  the  two  artificial  incisors,  and  thus  concealed  the  root  from 
view  (Fig.  91). 

1  could  describe  many  such  cases,  but  these  may  be  sufficient  to  show 
tliat  porcelain  enamel  can  be  used  to  advantage  for  large  defects. 

In  making  pivot  teeth  and  croivns  I   have  also 
Crowns.  had  good  results  with  the  Jenkins  enamel. 

For  a  pivot  tooth  select  first  a  platinum  pivot  that 
fits  the  root  well  and  cut  several  retaining  notches  in  it  with  an  Arthur 
disk.  Take  an  impression  of  the  root  and  grind  a  tooth  to  fit.  Bend  the 
pins  around  the  pivot,  as  seen  in  Fig.  92,  and  try  pivot  and  crown  thus 
joined  in  the  root.  If  the  tooth  has  been  ground  to  fit  perfectly,  remove, 
and  with  a  Herbst  polisher  burnish  a  piece  of  platinum  foil  upon  the  face 


56 


cf  the  root  prLijcciiUi^  noiii  Uie  gum.  The  positiuii  ut  the  root  canal 
will  be  plainly  marked.  Ptitting  some  wax  upon  the  artificial  crown, 
push  to  place  in  the  canal  and.  making  sure  that  the  crown  has  the  proper 
position,  withdraw  carefully;  the  foil  will  cling  to  the  wax  (Fig.  93). 
Then  imbed  in  a  melting  cup  which  Dr.  Jenkins  has  devised  for  thi^ 
special  purpose  and  which  has  a  platinum  spiral  to  receive  the  pivot 
(Fig.  94).  Fuse  porcelain  enamel  upon  the  reverse  of  the  crown  until 
you  have  it  as  seen  in  Fig.  95.  The  enamel  will  unite  so  closely  with  the 
artificial  tooth  that  if  the  bite  requires  it  it  can  l)e  cut  down  nearly  to  the 
pins  without  impairing  the  durability  of  the  tooth. 

In  constructing  these  pivot  teeth  we  must  beware  of  cooling  them  ott 
too  quickly,  since  artificial  teeth  crack  more  easily  than  the  fused  porcelain 
enamel. 


X'- 


( 


f 


Fig.  91. 


Fig.   92. 


Fig.    'A?.. 


The  Jenkins  powder  can  also  be  used  for  crowns  with  success.  In 
Fig.  96  is  shown  the  root  of  a  molar  with  a  ring  of  gold  fastened  with 
cement.  After  removing  the  superfluous  cement  take  an  impression  with 
goldfoil  and  fuse  porcelain  into  it.  Form  tlie  fissures  with  an  instrument 
before  the  mass  hardens. 

Dr.  Jenkins,  following  an  idea  of  Fenchel's, 
Sachet  Crown.  uses  porcelain  enamel  in  making  the  so-called  "jacket 
crown."  Fenchel  puts  a  platinum  ring  on  the  root, 
which  after  trying  in  he  gives  the  form  shown  in  Fig.  97.  Then  he  makes 
little  cuts  in  the  upper  rim  and  bends  as  seen  in  Fig.  98.  The  ring  can 
then  be  imbedded  in  asbestos  and  porcelain  enamel  fused  in  it.  \\\  means 
of  the  platinum  cut  in  ])arapet  shape  and  bent  inwards  the  porcelain  is  held 
so  securely  that  whole  crowns  can  be  built  u])  with  safety  (  Fig.  99). 

In  regard  to  this  Dr.  Jenkins  writes  as  follows:  "In  many  cases  of 
a  close  bite,  or  for  the  restoration  of  fractured  or  undeveloped  teeth  where 
the  pulp  is  still  alive,  this  jacket  crown  can  be  used  with  success.  It 
makes  a  very  strong  crown.'" 

Dr.  Jenkins  is  well  .satisfied  with  results  ()l)tained  by  the  hYMichel 
method,  both    in    res])ect  to  durability  and  ])eauty.  and  uses  it  in  lii'^  practice. 


Dr.  George  Evans,  of  New  York,  has  also  used 

methods  Of  the  Jenkins  enamel  for  other  operations  than  filling. 

Dr.  Geo.  €oan$.        He  employs  it  for  covering  gold  or  platinum  crowns 

with  a  layer  of  sightly  material. 

He  sometimes  cuts  off  the  pins  from  an  artificial  tooth  and  grinds  it 

so  thin  that  only  the  outside  labial  surface  remains  ;  he  then  fuses  this 

facing  upon  a  gold  crown,  using  porcelain  enamel  with  marked  success. 


Fig.   94. 


Fig.   95. 


"vTL- 


Fig.  97 


Fig.   98. 


Fig.     99. 


1  have  seen  Dr.  Jenkins  make  another  interesting 
molar  Crowns.  use  of  the  enamel  in  preparing  a  crown  for  a  lower 
molar.  He  made  a  platinum  ring  to  fit  perfectly  the 
edges  of  the  root ;  regulated  the  height  of  the  ring,  and  took  an  impression 
of  the  ring  and  root ;  then  soldered  platinum  upon  the  ring,  making  a  cai) 
that  perfectly  embraced  the  surface  of  the  root.  From  the  part  of  the 
ring  above  the  cap  a  piece  was  cut  out  on  the  buccal  side  and  a  half  molar, 
provided  with  a  backing,  was  soldered  on.  Then,  in  order  to  make  certain 
of  correct  articulation,  the  cap  was  tried  again  in  the  mouth. 

The  ring  was  now  filled  with  porcelain  enamel  powder  and  the  fusing 
continued  until  the  occlusion  with  the  antagonist  was  perfect.  The 
porcelain  united  with  the  tooth  most  compactly.  After  another  trial  in 
the  mouth,  the  platinum  ring  visible  above  the  gum  was  covered  with 
gum  porcelain  enamel.  Dr.  Jenkins  believes  that  he  can  make  no  stronger 
nor  more  durahle  crown  than  this. 


58 

I  have  also  made  a  crown  after  this  nietliod.  and  in  order  to  give  the 
ring  a  still  firmer  hold  on  the  porcelain  I  cut  and  bent  the  jilatinum  after 
Fenchel's  method  (Fig.  98). 

From  the  variety  of  examples  alread}  given  it  ma\  be  seen  how  great 
a  field  of  usefulness  opens  out  for  the  extended  use  of  porcelain  enamel, 
especially  if  one  most  carefully  takes  into  consideration  all  circumstances 
in  making  choice  of  it  for  each  particular  case. 

Having  come  now  to  the  conclusion  of  my  descriptions  of  Dr.  Jen- 
kins's method.  I  would  once  more  point  out  how  valuable,  when  properly 
and  conscientiously  used,  this  process  is.  both  to  our  ])atients  and  to 
ourselves. 

Its  introduction  constitutes  for  the  dental  profession  an  event  of  far 
reaching  significance,  and  ensures  for  the  discoverer  the  gratitude  of  all 
who  regard  dentistry  not  merely  as  a  scientific  handicraft,  but  rather  as 
calling  for  the  exercise  of  aesthetic  and  artistic  judgment  and  .skill. 


Conclusion. 

When  we  take  into  consideration  the  difificulty  wiib.  which  nearly  all 
our  most  useful  filling  materials  were  introduced  into  use,  and  read  in 
the  journals  of  earlier  decades  of  the  bitter  contests  waged,  for  example, 
against  amalgam,  a  material  which  no  dentist  today  could  spare,  w^e  can 
understand  that  there  is  likelv  to  be  much  opposition  to  the  filling  of  teeth 
with  porcelain. 

The  mistrust  of  new  discoveries  and  methods  is  to  a  certain  degree 
excusable,  since  it  often  occurs  that  quite  useless  innovations  (I  recall 
especially  many  of  the  preparations  for  treating  the  pulp)  are  extrava- 
gantly praised.  It  is  certainly  desirable  that  warnings  founded  on  experi- 
ence should  be  published  in  the  case  of  useless  and  worthless  things. 

When  Dr.  Jenkins,  whose  standing  as  a  practitioner  I  have  no  need 
to  certify,  made  known '  his  method,  after  years  of  experiment,  he  not 
only  explained  it  theoretically  in  a  manner  worthy  of  admiration,  but  also 
exhibited  it  practically  in  the  mouths  of  his  patients  with  brilliant  and 
almost  never  failing  success.  Stich  a  discovery,  thus  announced,  may  be 
received  at  once  with  a  good  degree  of  confidence.  That  in  this  case 
confidence  was  completely  justified  is  proven  by  the  many  satisfactory 
trials  of  this  method  made  by  German  dentists  and  reported  by  them  both 
verbally  and  in  writing.  So  much  the  more  astonishing  is  it  that  such 
really  useful  discoveries  are  often  subjected  to  unreasonable  criticism. 

Although  I  have  already  emphasized  the  excellence  of  the  Jenkins 
method  and  of  the  porcelain  enamel.  I  wish  in  conclusion  to  combat  some 
<>f  these  unfounded  criticisms. 


59 

In  describing-  the  setting  of  the  porcelain  hUing,  I  took  occasion  to 
deny  the  assertion  that  the  cavity  was  not  perfectly  closed  by  such  fillings. 
I  will  now  adduce  other  examples  showing  how  unjustifiable  are  some  of 
the  objections  urged  against  this  method. 

It  has   been   claimed   that  the  Jenkins  material 
Jenkins's  Porcelain    does  not  differ  essentially  in  composition  from  the 
not  Glass.  glass  powders  previously   in  use,   and   that  it  melts- 

over  a  Bunseii  burner,  ivhich  fact  justifies  the  sus- 
picio)i  that  it  is  nothing  more  than  a  glass  compound.  Since  I  have 
busied  myself  in  these  last  years  not  only  with  making  fillings  after 
the  Jenkins  system,  but  have  also  been  interested  in  studying  the  com- 
position and  the  fusing  point  of  the  porcelain  enamel  and  of  other  com- 
pounds of  like  nature,  I  am  prepared  to  give  some  particulars  upon  both 
these  points,  viz. :  that  the  Jenkins  material  is  believed  to  be  a  purely 
glass  mixture  and  that  it  melts  easily  over  a  Bunsen  burner. 

I  had  some  of  the  porcelain  mixtures  which  have  come  most  into 
use  analyzed  in  the  Chemical  Institute  of  the  Breslau  University,  the 
result  being  that  the  Jenkins  powder  is  shozvn  to  be  almost  identical  in 
composition — the  "variation  being  very  slight — ivith  the  so-called  "high 
fusing  porcelain"  as  zcell  as  zcitJi  the  hard  German  porcelain  tested  by 
H.  Seger  but  not  more  exactly  designated."^' 

As  to  the  fusing  of  the  Jenkins  powder  over  a  Bunsen  burner,  I 
am  not  surprised  at  it.  since  the  flame  of  the  Bimsen  burner  has  a  heat 
of  more  than  1.300  degrees  in  its  hottest  part,  in  which  heat  all  the  com- 
pounds used  for  porcelain  fillings,  including  even  the  high  and  low  fusing 
materials  used  by  Ash  in  liis  artificial  teeth,  may  be  melted. 

In  order  to  be  sure  of  this  I  made,  last  summer,  a  series  of  experi- 
ments in  the  Physical  Laboratory  of  the  University,  and  noted  the  melting 
]ioints  with  the  scientific  instruments  in  use  there. 

Begins  to  melt.       Melting  process  completed. 

Kaolith   (Glogau)  At  693  degrees At      870  degrees 

Glass  powder  (Herbst)  '"    790       "        ""       894 

Composition  (Moser)  "    810       '"        ""       890 

Porcelain  enamel  (Jenkins )    "    850       "        ""       910 

Ash's  "lowfusing."  "    865       "        ""     1.000 

The  figures  marking  the  beginning  of  the  melting  are  given  here  with 
addition  of  20  degrees,  because  this  was  the  temperature  of  the  room. 

From  this  table  it  clearly  appears  that  materials  having  a  still  higher 
meltitig  point  than  any  of  these  can  be  melted  over  a  Bimsen  luirner. 


*Von    Wagner.    Hamlbuch    der    Chcniisclien    Technologie.      I.eipsig,    Otto   Wiegand,   188t, 


60 

Ai   a    lueetiiig-  of   the    Brandenburg"   Society   of 
Grinding  Dentists,  Feb.  3  and  4,  1900,  the  Jenkins  compound 

and  Polishing.  was  charged  with  two  other  defects.     It  was  main- 

tained in  a  paper  read  on  that  occasion  that  the 
Jenkins  enamel  could  not  be  ground  and  polished  without  losing  its 
transparency,  and  it  was  asserted  by  another  speaker  that  fillings  of 
porcelain  enamel  became  dark,  indeed  almost  black,  in  the  mouth. 

As  to  the  first  assertion.  I  refer  to  my  remarks  on  the  sub- 
ject of  grinding  away  too  high  porcelain  fillings.  The  other  charge 
has  been  refuted  by  Torger  in  the  Zahiiarstliche  Rundschau  in  these 
words :  "A  discoloration  or  blackening  of  these  fillings  is  out  of  the 
range  of  possibility. "" 

I  have  myself  never  yet  found  one  among  the  large  number  of  fillings 
that  I  have  made  with  the  Jenkins  material  which  had  changed  color, 
hot  even  at  the  points  where  the  tooth  had  been  ground  and  polished.  Nor 
have  I  seen  any  sign  of  the  porousness  of  which  the  material  has  been 
accused  by  some. 

Prof.  Hesse,  in  his  last  lecture  on  the  Jenkins 
Retention  porcelain  tilling  before  the  Central   Society    (1901) 

by  Cement.  mentioned  the  mistrust  so  often  expressed  by  oppo- 

nents of  this  method  in  regard  to  the  retentive 
power  of  the  cement.  He  is  of  the  opinion  that  since  the  old  glass  and 
porcelain  fillings  have  stood  the  test  for  years  though  held  in  place  only 
by  cement,  it  was  not  the  lack  of  durability  in  the  cement  but  of  the 
material  of  which  the  fillings  were  composed  that  gave  cause  for  com- 
plaint. So  long  as  we  have  no  more  trustworthy  material  for  fastening 
inlays  in  place,  w'e  must  let  wdiat  we  have  suflfice.  The  most  of  the 
attacks  on  the  Jenkins  method  are  based  on  an  insufficient  freedom  from 
prejudice  or  on  an  inadequate  experience  in  the  use  of  the  material. 
Whoever  will  make  hiniself  acquainted  with  the  brilliant  results  thai. 
have  been  attained  will  gladly  enroll  himself  among  the  great  number 
of  the  followers  of  this  system.  Only  years  of  practice  with  a  new  filling 
material  can  qualify  us  to  give  a  final  judgment  upon  its  capabilities  and 
durability.  One  should  not  allow  himself  to  be  led  to  a  premature 
condemnation  on  account  of  failures  at  the  beginning. 

Undoubtedly  the  future  of  operative  dentistry  is  to  be  in  large 
measure  concerned  \\ith  the  employment  of  porcelain  as  a  filling  material, 
and  we  may  expect  with  increasing  perfection  in  the  methods  and  materials 
that  we  shall  in  time  possess  that  which  is  so  much  needed — a  compoimd 
that  shall  meet  all  the  ref|uirements  that  we  must  flemand  of  an  "ideal" 
filling  material. 


61 

Jlppcndix. 

Porcelain  Inlays. 

In  the  section  devoted  to  the  historical  development  of  the  method 
of  filling  teeth  with  porcelain.  I  have  mentioned  the  use  of  pieces  of 
artificial  teeth  as  inlays.  I  can  therefore  restrict  myself  here  to  a  few 
remarks  which  may  give  a  better  idea  of  these  fillings.  There  have  been 
several  ways  in  use  of  making  porcelain  inlays.  The  simplest,  it  seems 
to  me,  is  that  recommended  by  Prof.  Sachs.     He  selects  a  front  tooth  of 


fSHHHMKl 


Fig.  101. 


u 


i 

Fior.     102. 


•  i  u 


White's  manufacture  which  matches  in  color  the  tooth  to  be  filled  and 
cuts  out  of  it  a  round  piece  w^hich  nearly  corresponds  in  size  to  that  of 
the  cavity.  Fastening  this  with  shellac  to  the  end  of  a  burr,  he  lets  the 
engine  revolve  to  the  right  while  he  holds  the  porcelain  against  a  fine 
grained  wheel  of  the  lathe  revolving  in  the  opposite  direction.  One  can 
also,  in  order  to  obtain  a  more  perfect  joint,  fill  the  cavity  with  wet 
pumice  or  emery  powder  and  thus  polish  to  a  nicety  in  the  cavity  itself. 

The  pieces  are  given  a  somewhat  conical  form,  so  that  if  they  do  not 
at  the  first  trial  exactly  fit  the  cavity  the  small  end  can  be  cut  away  and 
the  piece  sunk  deeper  into  the  cavity.  The  lower  part  is  grooved 
(Fig.  lOo),  and  a  groove  is  also  made  in  the  tooth.  Later,  in  order  not 
to  consume  too  much  time  in  preparing  an  inlay  for  each  case,  Sachs  made 
out  of  artificial  teeth  which  had  been  discarded  for  other  uses  a  large 
number  of  porcelain  inlays  of  various  sizes. 

Another  method  is  (by  means  of  one  of  White's  trephines  (Fig.  loi ), 


which  arc  made  of  copper  charged  witli  tHam.nd  dust,  and  can  be  had 
in  several  sizes)  to  cut  from  the  selected  tooth  a  piece  of  the  required 
size.  This  method  has  the  advantage  that  one  can  cut  out  from  the 
artificial  tooth  the  piece  which  best  matches  the  shading  of  the  natural 
one  and  will  render  the  defect  least  visible.  There  are  also  to  be  had  for 
this  work  cylindrical  burs  having  the  same  diameters  as  the  trephines 
(Fig.  102). 

For  holding  these  small  porcelain  inlays  while  being  ground.  How 
has  made  some  metallic  rods  (Fig.  103),  which  are  to  be  set  in  a  mandrel 


I 


Fig.  103. 


•ig.  104. 


Fig.  105. 


mm 


Fig.    lOG. 


l"ig.   107. 


as  shown  in  Fig.  104,  for  use  on  the  engine.  By  this  means  the  inlay 
can  be  given  the  desired  shape  by  holding  it  against  fine  grained  corundum 
or  emery. 

White  and  Ash  have  also  prepared  for  porcelain  inlay  work,  from 
the  same  substance  as  their  mineral  teeth,  small  rods  of  various  shapes 
and  colors  from  which  the  piece  required  can  be  cut  ofif  (Figs.  105 
and  106).  Finally  I  would  mention  the  inlays  manufactured  by  Aslj  for 
large  cavities,  some  of  them  provided  with  platinum  pins  for  molar 
teeth   (Fig.  T07). 


63 


All  these  methods  have  been  superseded  by  Ball's  system,  which  has 
greatly  simplified  the  work  and  essentially  shortened  the  time  necessary 
to  prepare  such  fillings. 

Dall's  System. 

Dall  engaged  the  firm  Ash  &  Sons  to  furnish  so-called  "ground 
inlays/"  made  of  the  same  material  as  their  artificial  teeth,  in  sizes  cor- 
responding to  a  steel  gauge  (Fig.  io8).     These  inlays  are  of  two  thick- 


DALL'  s 
INLAY   GAUGE 


Dalls 
Ground  Inlays 


Deep      Shallow 

I'lg.    1U9. 


Bur 


Fig.  no. 


C.ASHlSONS 
ENGLAND. 


oooO 


li 


Z7 


Li 


Fig.  ni. 


Fig.  112. 


Fig.  108. 

nesses  (Fig.  109 j  ;  both  have  grooves  on  the  under  side,  and  on  the  outer 
a  little  button  by  which  the  inlay  may  be  seized  with  the  pliers,  which 
makes  the  trying  in  and  setting  much  easier.  The  thicker  inlays  have  a 
retaining  groove.  There  are  twenty-five  sizes  of  inlay  corresponding  to 
the  same  number  of  holes  in  the  gauge,  and  also  twenty-five  large  burs 


H4 


marked  on  tlie  shaft  w  itli  the  lUimbcr  corresponding  to  the  gauge 
(Fig.  no).  Tliese  burs  are  sHghtly  conical  in  shai)e  and  give  the  cavity 
tlie  exact  form  of  the  inlay  selected. 

Dall  has  also  constructed  four  inlay  holders  (Fig.  iii)  for  use 
when  the  inlav  has  to  be  ground  away  on  the  under  side.  The  top  of 
the  inlay  with  the  button  is  fastened  into  the  holder  with  shellac. 

The  process  of  setting  such  inlays  on  labial  surfaces  is  as  follows: 
Remove  all  decay  from  the  cavity  with  a  rose  bur,  and  with  the  burs 
above  described  give  it  a  circular  shape  :  in  doing  this  take  great  care 
to  hold  the  bur  jierpendicular  to  the  required  plane  of  the  filling  and  that 
the  bur  runs  true  in  the  handpiece,  or  tlie  desired  form  will  not  be 
obtained. 


Pis.  n;:. 


Fig.    114. 


iMg.    115. 


Fig.   110. 


When  the  cavity  has  sufficient  depth,  make  an  undercut  with  Ball's 
undercut  bur  (Fig.  1 12).  With  the  pliers  take  the  inlay  which  corresponds 
with  the  size  of  the  bur  and  place  it  in  the  cavity.  If  it  is  too  high,  the 
lower  surface  may  be  ground  away  until  it  corresj^onds  with  the  edges 
of  the  cavity,  but  there  must  never  be  so  much  taken  away  that  the  edge 
of  the  cavity  is  above  the  inlay,  but  the  edge  of  the  inlay  must  always 
stand  a  trifle  above  the  edge  of  the  cavity  wall.  If  there  is  no  retaining 
groove  in  the  piece  selected,  one  is  easily  made  with  the  diamond  wheel 
(Fig.  113),  always  kept  wet. 

After  putting  a  little  cement  of  the  consistency  of  cream  into  the 
retaining  grooves  in  both  inlay  and  tooth,  set  the  piece  with  a  small 
surplus  of  cement.  The  little  button  is  to  be  nicked  with  the  diamond 
wheel  and  excised.  When  the  cement  is  hard,  remove  the  extra  portion 
with  a  corundum  disk  and  polish  the  surface  of  the  porcelain  inlay  with 
an  Arkansas  stone. 

We  prefer  these  inlays  to  melted  fillings  for  small,  round  cavities. 
The  cuts  114  to  it6  show  cases  in  which  the  use  of  the  Dall  system  is 
advantagreous. 


65 


For  all  irregularly  shaped  cavities,  or  when  to  make  a  round  cavity 
would  involve  too  much  destruction  of  tooth  substance,  we  prefer  the 
Jenkins  method.  This  only  requires  that  we  remove  the  decav  and  enough 
tooth  substance  to  prevent  secondary  caries.* 


*It  should  be  said  that  Dall  has  in  view  the  preparation  of  inlays  of  irregular  shape,  but  1 
maintain  that  for  such  cases  fillings  melted  in  an  exact  impression  of  the  cavity  more  completely 
fulfill  the  purpose  sought. 


Citerature. 

Bkuck,  J. — Lclirhuch  der  Znlinheilkumic.  Berlin.  A.   Fiirstncr,   18o(). 

CoMEGYS. — Zalintlcisclifaiiiigc  Porzollanfullungen  (Gum-colored  porcelain  fillings). 
Dental  Cosmo?.  March.   1889. 

D.\Ki!v,  E.  T. — Remarks  liefore  the  National  Dental  .Association.  Dental  Cosmos, 
189fl.  p.   1188. 

Drx.v.  C.   W. — Enamel   Fillings.   British  Journal   of   Dental   Science.   1885. 

Ekx-SMEre,  J.  B. — Porcelain  Dental  Work.  Dental  Cosmos.  February.  liHiu. 

Ev.\xs,  Geo. — Remarks  before  the  Xat.  Dental  .\ssn..  Dental  Cosmos.  18911.  p.  1171. 

Ev.\xs.  Geo. — Remarks  before  the  X.  Y.  Odontological  Society.  Dental  Cosmos, 
1900,  p.  183. 

Fexthol.— Die  neueren  Fullungsmaterialen.  Deutsche  Monatsschrift  fur  Zahnheil- 
kunde.  Jan.,  1892. 

Gi.oG.vu. — Kaolith.   eine  neue   Porzellanemaille,  Zahnarztliche  Rundschau.   1900. 

Hesse. — Porzellanfullungen  nach  Jenkins.  Deutsche  Mcnat^schrifi  fur  Zahnheil- 
kunde,  19nl. 

HiKscHFEi.i),  W. — How  to  Overcome  the  Dit^cullie-  in  Dr.  Jenkins's  System  of 
Inlays.  Dental   Cosmos.   1899,   p.  489. 

HoLxnuEK. — Erfahrungen  niit  Glasfiillungen.  Deutsche  ^[on.  fitr  Zahnheilkunde, 
Mai.  189-2. 

H.\KT.M.\x.\.  .AxTox  Jllils. — Einigcs  iiber  Gla.sfiillungen.  Deutsche  Mon.  fiir  Zahn- 
heilkunde.  .Aug..    18911. 

He.\d,  J. — The   Shadow   Problems  of  Porcelain  Inlays,  Dental  Cosmos,  June.  1900. 

He.xd.  J. — Remarks  in  the   Xat.   Dental  Association,  Dental   Cosines,   1899.  p.   1170. 

He.\I).  J. — The  Status  of  the  Inlay  as  Compared  With  Other  Fillings.  Dental 
Cosmos.   1900. 

How.   W.   Stoker. — Porzellanfiillungen.  Correspondenzblatt   fiir   Zahnarzte.   1889. 

Herbst.  W. — Glas  als  Fiillmaterial.  Correspondenzblatt  fiir  Zahnarzte.  1889.  April- 
heft. 

Jexkixs.  X.   S. — Porcelain  Inlays.  The  Dental   Register.  Vol.  ol.  June.  1897. 

Jenkixs.  X.  S. — Porcelain  Enamel  for  Inlays  and  Pivot  Teeth.  Dental  Record. 
Aug..  1898. 


LITERATURE.  67 

Jexkixs.  X.   S. — Porcelain  Enamel  Inlays.   Dental   Cosmos,   1898,   p.  633. 

Jenkins.   X.  S. — The  Perfected  Porcelain  Enamel,  Dental  Cosmos.   1899.  p.  84. 

Land. — A  Xew  System  of  Restoring  Badly  Decayed  Teeth  by  Means  of  an 
Enamelled  ^^letallic  Coating.  The  Independent  Practitioner,   Aug..   188G. 

Lanu. — Metallic  Enamel  Sections:  a  Xew  System  for  Filling  Teeth,  in  the  same. 
Feb.,   1887. 

LiNDEREK.   J. — Handbuch  der  Zahnheilkunde.   Bd.   II,   1847. 

LiNUEKEK,  J. — Fournieren  nnd  Plattiertn  der  Zahne,  Deutsche  Vierteljahrsschrift  fiir 
Zahnheilkunde,    1874. 

Miller.  \V.  D. — Lehrbuch  der  conservierenden  Zahnheilkunde.  Leipzig.  Geo. 
Thieme.  189G. 

Miller.  \V.  D. — Wiederherstellung  der  Contur  carios  gewordener  Zahne  durch 
Porzellanstiickchen.  Osterr.-Ungarische  \'ierteliahrsschrift  fiir  Zahnheilkunde 
Jan.,  1887. 

Mu.i.EK,  W.  D. — Die  Ausgleichung  von  Zahndefecten  mittels  Porzellaneinlagen, 
Odontologische  Blatter.  Mai.  1899. 

MoESEK,  Ernst. — Homogene   Email-Einlagen.  Odontologische  Blatter,   1899.   S.   120. 

MoESER. — Durchsichtige  Glasfiillungen.  Deutsche  Monatsschrift  fiir  Zahnheilkunde, 
Xov..  1897. 

MoESER. — Die   Herstellung  homogener  Einlagen  zu  Zahnfiillungen  ohne   Brennofen, 

Deut.sche  Monatsschr.  fiir  Zahnheilkunde,  Juli.  1899. 
Murphy. — Popular    Treatise    on    the    Structure.    Diseases    and    Treatment    of    the 

Human  Teeth.  London,  1837. 
Oenicke,  G.  a. — L'eber  das  Ausfiillen  cario-^er  Zahne  mit  Riicksicht  auf  das  Plat- 

tieren   und   Fournieren  derselben.  "Der  Zahnarzt."   1847. 
Rollins.  W.  H. — Enamel  Fillings,  Archives  of  Dentistry,   1835. 
Sachs.  W. — Die  Technik  in  der  conservativen  Zahnheilkunde,  Deutsche  ^lonat.  fiir 

Zahnheilkunde.  Juni,  1889. 
Sachs.   W. — Discussionsbemerkungen    zu   dem   Vortrag   des    Prof.    Hesse:       "Por- 

zellanfiillungen  nach  Jenkins."     Correspondenzblatt  fiir  Zahnjirzte,  April,   1901. 
Sachs.  W. — Glasfiillungen.     Deutsche  Monat.  fiir  Zahnheilkunde.  June,   1890. 

Sachs,   \V. — Das   Fiillen  der  Zahne.      "Handbuch   der  Zahnheilkunde"   von   Scheff, 

Wien  189-2.  A.  Holder. 
SiFFRE,  A. — Les  procedes  de  vitrification  appliques  a  I'obturation  des   dents,  Revue 

Odontologique.  1899. 
Smreker,   Ernst. — Einige  Kunstgriffe  beim   Fiillen   der   Ziihne.     Wiener  Zahnarzt- 

liche,  Monatsschrift.  Mai,  1901. 


68 


LiriiRAri'Rii. 


Stokes.  J.  L. — Porcelain  Filling.s,  SoutlRrn    IXntal  Journal,   1887. 

Thompson.  A.   H.— Gum-colored   Porcelain  Fillings,  Dental  Cosmos,  Mar.,  1889. 

VoLCK,  A.  J.— Am.  Journal  dt   Denial  Science.  July.   1857. 

Webb,  M.\rsh.\li.  H. — Ueber  die  Verwendung  von  I'orcellanstucken  zur  Fullung 
von   Cavitiiten.      Correspondenzhlatt    fiir  Zahniuzie,    188_'. 

Brixk.  \\ . — Leber  die  neuen  Jenkins'scben  l^'orzellanemaillen.  Deutsclie  Monat. 
fiir  Zabnbeilkunde.   18!I8. 

Bruck.  \V.- — Die  Thatigkcil  der  Abteilung  fiir  conservirende  Zahnheilkunde  am  zabn- 
arztlichen  Institut  der  k(")niglicben  Universitiii  P>re>-lau  w.ibrend  des  Snnnner-e- 
mesters,  IfKXi.     Deutsche  Monat.  fur  Zabnbeilkunde.  Heft  9.  lOUO. 


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The  filling  of  teeth  with 

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JUNES J954  (y  '  ^       ^}^s^^^, 


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